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CenterLight Health System MANAGER OF CLINICAL ASSESSMENT TEAM in Flushing, New York

JOB PURPOSE:

This position will ensure effective and efficient completion of tasks associated with the clinical assessment process including but not limited to clinical onboarding and reassessment, UAS-NY completion, medication review, and post-hospital discharge evaluation. The Manager of Clinical Assessments will follow all Department of Health policies and regulations pertaining to the Uniform Assessment System of New York (UAS-NY) as well as Intake workflows related to accurate and timely completion of UAS assessments. The Manager of Clinical Assessments serves as a valuable resource to the Intake and Enrollment and Care Delivery teams by documenting critical clinical enrollment, reassessment, and change in condition information in the electronic record system.

JOB RESPONSIBILITIES:

  • Responsible for UAS-NY oversight for CenterLight.

  • Manages the completion of in-home assessments for PACE participants utilizing the UAS-NY to determine initial or continued plan eligibility in accordance with requirement need of Community Based Long Term Care Long Term Care (CBLTC) Services for greater than 120 days, and care needs.

  • Manages a team of clinical assessment nurses and reviewers to ensure the seamless and timely completion and quality of assessments.

  • Works with the Intake and Enrollment Department to ensure timely scheduling and completion of nurses’ assessments.

  • Manages the development of the proposed service plan and works closely with intake and enrollment and care delivery teams to ensure timely and accurate completion and documentation of in-home or virtual assessment appointments with prospective or enrolled participants (utilizing the UAS-NY).

  • Ensures education of potential/new PACE participants on plan benefits, services, and care delivery model.

  • Develops processes, policies, and workflows necessary to meet enrollments, and business goals.

  • Maintains knowledge and updates staff/processes of all applicable CMS/NYSDOH/PACE guidelines and relevant organizational and departmental policies and procedures, including but not limited to, the timely conduction, finalization, and documentation of the UAS-NY.

  • Ensures compliance with eligibility, enrollment, and disenrollment regulations.

  • Integrates new eligibility and assessment rules and CMS/NYSDOH regulations into ongoing activities.

  • Engages in continuous quality improvement programs and activities to promote optimal staff performance and participant outcomes.

  • In conjunction with the other arms of the Business Development Department, works to identify referral trends that will lead to conversion of appropriate PACE candidates into the program and improve the overall quality of enrollments.

  • Collaborates with Care Delivery leadership and other members of the Care Delivery team. Provides significant clinical information in advance of enrollment to ensure smooth transition and appropriate opportunity for Care Delivery preparation of new participants with complex health conditions.

  • Partners with Care Delivery by meeting with site leadership and IDT to provide Clinical Assessment and Intake updates, address concerns and improve overall process.

  • Serves as clinical point person in response to Care Delivery question, concerns, or issues after enrollment.

  • Develops and analyzes reports pertaining to the Intake and Enrollment process as it relates to the clinical program component and quality of enrollment.

  • Ensures that documentation is timely, accurate, appropriate and meets timeframes as determined both by the department and governmental agencies.

  • Understands rules and regulations of Medicare and Medicaid and their application to specific participant issues, conveys updates from the above and other governmental agencies to Clinical Intake staff and other stakeholders as needed.

  • Analyzes department productivity and identifies areas for improvement.

  • Interviews, hires, trains, manages, and progressively disciplines and counsels all staff in the department.

  • Engages in staff development and the development of training materials for staff’s continuing education.

  • Manages relationship with contracted agencies. Includes general oversight of day-to-day operations, providing oversight and assistance to agency contracted nurses, obtaining regular vendor staffing updates so required documents are supplied to HR, reconciling invoices to ensure accuracy, and approving payment to vendor, participating in strategic meetings involving contractual agreements and working process.

  • Develops departmental policies and procedures and efficient workflows and processes.

  • Trains clinical staff on assessment visits, UAS-NY, PCAT, assessment tools and capturing quality measures.

  • Maintains and generates required reports, including but not limited to Quarterly NYSDOH PACE Report, CMS Monthly Meeting Data, and Quality Improvement Committee Reporting.

  • Remains responsive and available by phone/email for contact by CenterLight staff.

  • Must be able to work some weekends and ability to travel to various boroughs for training purposes and ride-alongs.

  • Supports new staff with onboarding to ensure supportive, collaborative, and efficient transition of new staff to the Clinical Assessments Team

  • Promotes and educates potential referral sources about the PACE program as needed to encourage participation in the program through presentations, lectures, meetings, or other support.

  • All other duties as assigned

QUALIFICATIONS:

Education: Registered Nurse NY State License, BS in Nursing or other health-related area preferred

Experience:

  • Three to five (3-5) years in MLTC, LTHHCP, MAP, PACE or other managed care program.

  • Experience in working independently without significant oversight and or direction from a supervisor.

  • Minimum five (5) years of experience in care/case management, disease management, population health management, utilization review, quality assurance or discharge planning (preferably within a managed care, home care or community health organization).

  • Proficiency utilizing and analyzing UAS-NY and Lenavi.

  • Experience with Customer Relationship Management platforms and clinical management systems

Other:

  • Positive attitude and outlook with the ability to multi-task in a constantly changing environment

  • Flexibility one weekend to meet deadlines.

  • Highly motivated and self-driven individual with willingness to work within a strict deadline environment.

  • Proficiency in Microsoft office products; report development and strong writing skills

  • Excellent communication and interpersonal skills required.

  • Customer Service oriented with strong clinical management skills

  • Work on-site in the Flushing office.

  • Bilingual skills strongly preferred.

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