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Molina Healthcare

Runs health plans for government programs

Uniform System Assessor Nurse

Medical, Clinical & VeterinaryUpdated on Nov 11
Full-timeNew York, NY, USA$24 - $56.17 /hr

About the Job

Requirements

  • At least two years of clinical experience in managed care, including case management and home visit experience, or an equivalent combination of relevant education and experience.
  • Be a Registered Nurse with an active, unrestricted license in the state of practice.
  • Reside in New York or a neighboring state (New Jersey, Connecticut, or parts of Pennsylvania) and have a New York state government ID.
  • Be trained and knowledgeable in the New York Uniform Assessment System (UAS).
  • Be able to travel to multiple boroughs by car or public transportation.
  • Understand and apply principles of care management and person-centered planning.
  • Have solid assessment skills.
  • Understand and apply coverage guidelines and benefit limitations.
  • Be familiar with clinical needs and disease processes for chronic physical and behavioral illnesses.
  • Understand and adapt appropriately to issues related to member communication, cognitive barriers, or other barriers.
  • Have organizational skills and the ability to prioritize and follow through on multiple projects in a timely manner.
  • Have effective verbal and written communication skills.
  • Be proficient in Microsoft Office and applicable software programs.

Responsibilities

  • Complete approved New York State initial assessment tools and/or clinical reassessments used to define member eligibility for community-based long-term care services.
  • Complete enrollment paperwork, progress notes, and tasking tools in member homes to help determine eligibility for services, and review collected data for accuracy and completeness before submission.
  • Chart all contacts and findings in the appropriate tools and forms, in accordance with policy and procedure and within established deadlines.
  • Attend training and continuing education focused on proper completion of Comprehensive Health Assessment (CHA) documentation, enrollment paperwork, and tasking tools.
  • Continuously improve the quality of materials associated with initial and continued enrollment of members in the plan.
  • Support initiatives of the quality assessment and performance improvement committee.
  • Travel daily within assigned local territories based on state and contractual requirements.
  • Visit members at their homes or facilities.

Desired Qualifications

  • Certified Case Manager (CCM) or Chronic Care Professional (CCP) certification.
  • Home care or long-term care experience.
  • Community support service experience accessing and using durable medical equipment (DME).
  • Experience in utilization review, concurrent review, and/or risk management.
  • Bilingual or multilingual ability.
  • Ability to commute as needed to meet members in person at their homes or facilities.

About the Company

Molina Healthcare

Runs health plans for government programs

Molina Healthcare runs health insurance plans for people covered by Medicaid, Medicare and state insurance marketplaces, with a focus on people who need affordable access to care. Its local health plans coordinate medical services and support members with complex health needs, including people eligible for both Medicaid and Medicare. Members receive care through networks of doctors, hospitals and other providers, while the plans manage benefits, process claims and arrange care support. The company earns premiums from government programs and members, and pays the cost of covered healthcare services. Molina was founded in 1980 and is headquartered in Long Beach, California.

Company size
10,001+
Company stage
IPO
Headquarters
Long Beach, CA
Founded
1980

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