Centers Plan for Healthy Living's goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision makers, and general caregivers with the guidance and plans they need for healthy living.

JOB SUMMARY:

The Assessment Nurse, works in collaboration with the Care Management team and is responsible for assessing a member's eligibility for the Centers Plan for Health Living's (CPHL all LOB programs. The Assessment Nurse will conduct a face-to-face comprehensive assessment utilizing NYSDOH approved assessment tool (UASNY) and risk acuity visits with a member in his/her place of residence. The Assessment Nurse is a member of the interdisciplinary care team (IDT).
The members interview, assessment and documentation process are a core component of CPHL care management delivery model. Interdisciplinary Care Team (IDT) works together to evaluate, assess and develop a comprehensive, person-centered plan of care that is based on the responses to the assessment. The components of the assessment and plan of care are structured to ensure quality and consistency that support improved member outcomes and seamless care coordination amongst the members of IDT.

PRIMARY RESPONSIBILITIES:
Included but not limited to:
Performs comprehensive UASNY assessments including Functional and mental supplements as triggered of a member making appropriate determination for a member's eligibility into the program (s)
Determines level of member risk acuity based on the comprehensive assessment
Performs face-to-face Initial Care Visit (ICV) and ongoing visits based on the member acuity level
Identifies medical, functional, psychosocial, behavioral health, cultural and linguistic needs of the member and discusses member/family active engagement in development of person-centered service and care plans and decision-making.
Effectively completes the required assessment form (UASNY) and other Centers Plan for Healthy Living (CPHL) necessary documents within the required timeframes and in accordance with CHPL established policies and procedures and State and Federal guidelines and regulations.
Participates in the IDT.
Effectively collaborates with the Care Managers to establish continuity of care and interventions as they relate to members' needs addressing any urgent needs of a member
Recognizes quality of care issues, escalates the issues appropriately to the care manager, and discusses issues at the IDT.
Complies with all CPHL's standards for documentation.
Maintains member confidentiality and compliance with HIPPA requirements
Participates in regularly scheduled and other staff meetings as requested
Participates in quality improvement initiatives
Other duties as assigned
EDUCATION AND EXPERIENCE:

Type of Experience

Understanding of and sensitivity to cultural differences and needs of the community are essential. Must be adept at operating within a diverse and multi-cultural work environment and community of members such as Spanish, Chinese, Russian, Creole and Korean

Required:
Active and unrestricted NYS RN license
Strong written and verbal communication skills.
Must possess a valid driver's license, motor vehicle insurance and access to a motor vehicle, or access to reliable public transportation within the appropriate service area
Ability to travel within assigned area
Preferred:
Bachelor of Science in Nursing or advanced degree
Preferred:
Experience providing care in the home setting
Experience working within a managed care environment
Specific Technical Skills
Required: Computer proficiency

SCOPE INFORMATION
# Direct Reports: 0

PHYSICAL REQUIREMENTS:

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Must be able to operate office equipment including a computer and phones
Able to communicate both in person and by phone
Must be able to travel as needed
The above statements are intended to describe the general nature and level of work performed by individuals assigned to the job classification. They should not be construed as an exhaustive list of all responsibilities, duties and skills required.

Centers Plan For Healthy Living is committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our employees and our business. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law and will not be denied employment.