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Clinical Supervisor Assessment Unit
Overview
Assists Assessment Unit management in the day-to-day clinical operations of UAS assessments for VNS Health Plans. Ensures staff have the appropriate support to provide an efficient and effective enrollment process. This includes education, marketing, enrollment workflows, and administration of the enrollment process. Works under general supervision.
What We Provide
- Referral bonus opportunities
- Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
- Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
- Employer-matched retirement saving funds
- Personal and financial wellness programs
- Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
- Generous tuition reimbursement for qualifying degrees
- Opportunities for professional growth and career advancement
- Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities
What You Will Do
- Provides input to Education team regarding gaps in educational materials used by the Assessment Unit to educate internal staff and external vendors regarding the types of customers appropriate for MLTC/MLTC MAP.
- Assists Assessment Unit manager in the review/analysis of Quality Scorecard Outcomes; identifies potential trends.
- Assesses effectiveness of Assessment Unit policies and procedures. Makes recommendations for improvements and oversees implementation of any changes.
- Establishes positive working relationships with internal and external staff, referral sources, including but not limited to VNS Health programs, hospitals, physicians, medical groups, community service agencies, community leaders, healthcare professionals, etc. to assist in program expansion. Assists manager in revising comprehensive assessment tools to be used to evaluate protentional new members.
- Provides supervisory visits to ensure that assessments meet the requirements for Community Based Long Term Care Services.
- Audits staff documentation to ensure timeliness for submission of assessments so that enrollments can be processed.
- Collaborates with manager to analyze and summarize monthly reports to identify current trends of assessment cancellation, deletions and disputes. Recommends strategies to address trends and ensure continued growth of the program.
- Reviews and monitors processing of new referrals, development of treatment plans for new enrollees and the documentation of prescribed services to ensure all pre and post enrollment activities are in accordance with VNS Health Plans policy, regulatory requirements and quality standards.
- Participates in the preparation of summary reports of enrollments, deletions, withdrawals, deferrals, CASA conversions, etc. required by HRA and DOH. Acts as a liaison between MLTC/MLTC MAP Plans, HRA and responds to requests for clarification or information regarding assessment documentation.
- Participates in case conferences with Medicaid Eligibility Unit, Assessment Unit, Utilization Management, Grievance and Appeals, Vendors and Care Management to resolve concerns that may hinder the assessment from being promoted to enrollment.
- Conducts marketing activities to potential new members, physicians and community resources designed to increase member participation.
- Participates in the review of clinically complex cases to ensure potential new members receive appropriate services based on clinical guidelines, evidenced base practices and medical necessity. Reviews and submits required documents on clinically complex cases to Medical Director so that a review and timely decision is made.
- Works with Medicaid Eligibility Unit to ensure all viable cases are scheduled timely.
- Performs all duties inherent in a supervisory role. Ensures effective staff training, interviews candidates for employment, evaluates staff performance, and recommends hiring, promotions, salary actions and terminations as appropriate.
- Participates in special projects and performs other duties as assigned.
Qualifications
Licenses and Certifications:
Current license and registration to practice as a Registered Professional Nurse in New York State RequiredValid driver's license or NYS Non-Driver photo ID card, may be required as determined by operational/regional needs.
Education:
Bachelor's Degree in Nursing from an approved program accredited by the National League of Nursing Required orBachelor's Degree in a health or human service field and two years of experience in Long Term Care environment or a combination of education, experience and/or training Required
Work Experience:
Minimum two years of experience in home care RequiredKnowledge of enrollment and delivery of care processes within a long-term care program, Medicare and Medicaid standards, and nursing needs of the elderly, chronically ill or disabled populations RequiredProficient with personal computers including MS Office applications Required
Pay Range
USD $93,400.00 - USD $116,800.00 /Yr.
About Us
VNS Health is one of the nation’s largest nonprofit home and community-based health care organizations. Innovating in health care for more than 130 years, our commitment to health and well-being is what drives us — we help people live, age and heal where they feel most comfortable, in their own homes, connected to their family and community. On any given day, more than 10,000 VNS Health team members deliver compassionate care, unparalleled expertise and 24/7 solutions and resources to the more than 43,000 “neighbors” who look to us for care. Powered and informed by data analytics that are unmatched in the home and community-health industry, VNS Health offers a full range of health care services, solutions and health plans designed to simplify the health care experience and meet the diverse and complex needs of the communities and people we serve in New York and beyond.
