Job Description

Job Summary

Responsible for the completion Community Health Assessment (CHA) formerly the UAS (Uniform Assessment System) Initial Assessments and Reassessments based on New York State requirements, guidelines, and training provided by the company and/or outside resources; enrollment paperwork materials required to appropriately process members’ application for enrollment, and CHA Tasking Tool based on guidelines and training provided by the company and/or outside resources. Responsible for corrections and revision of CHA paperwork and tasking tool documentation based on review and feedback provided through quality and associated review process.

This position will support our Senior Whole Health business. Senior Whole Health by Molina is a Managed Long-Term Care (MLTC), and Medicaid Advantage (MAP) plan. These plans streamline the delivery of long-term services to chronically ill or disabled people who are eligible for Medicaid and Medicare. We are looking for a RN candidate with a Uniform System Assessor (USA) or Home Care background.  The candidate must have strong organization, communication, technologically proficient and time management skills. This position requires the ability to  work in a high-volume environment to serve our members. Bilingual candidates that speak Spanish, Chinese, or Bengali are encouraged to apply.

Work hours Monday- Friday 8:00am- 5:00pm EST

Remote position with required field travel in the Bronx, Manhattan, Syracuse, or Albany New York. (Your territory will be determined by where you reside)

Knowledge/Skills/Abilities

• Completes approved New York State Comprehensive Health Initial Assessment Tool and/or Clinical Reassessment used to define eligibility for community based long term care services; develops plan of care for members

• Completes enrollment paperwork, progress notes and tasking tool in members’ home to assist in determining eligibility for services; reviews all data collected for accuracy and completion prior to submission

• Charts all contacts and findings within appropriate tool and form per policy and procedure within deadlines

• Attends training and continuing education sessions focused on the proper completion of Comprehensive Health Assessment documentation, enrollment paperwork, and tasking tool.

• Focuses on continuous improvement and quality excellence in the completion of all material associated with the initial enrollment/continued enrollment of members in the plan

• Supports initiatives of the Quality Assessment and Performance Improvement Committee

• Trained and knowledgeable in the NY UAS. Ability to understand and apply principles of Care Management and Person-Centered Planning

• Solid assessment skills

• Ability to understand and apply coverage guidelines and benefit limitations

• Familiar with clinical needs and disease processes for chronic physical and behavioral illnesses

• Understands and adapts appropriately to issues related to communication, cognitive or other barriers

• Strong organizational skills and the ability to prioritize and follow through on multiple projects in a timely manner

• Must be able to travel to multiple boroughs via car or commuting via public transportation

• Basic computer skills

Job Qualifications

Required Education:

• Associates degree in Nursing

Required Experience:

• Minimum two years clinical experience with focus in managed care, including disease or case management

• UAS experience

• Experience conducting home visits

Required Licensure or Certification:

• Registered Nurse (RN)

State Specific Requirements:

• Must reside in the state of NY or neighboring states (NJ, CT, parts of PA). Must have a NY state government ID

Preferred Qualifications: Provide any preferred education, experience, licensure or Knowledge, Skills and Abilities

Preferred Qualifications:

• Bachelor’s degree in Nursing

• CCM- Certified Case Manager, CCP – Chronic Care Professional.

• Home Care, Long-Term Care, MLTC experience, including appropriate support services in the community and accessing and using durable medical equipment (DME).

• Experience in utilization review, concurrent review and/or risk management a plus.

• Bilingual or multi-lingual.

• Health Commerce User Role 40

Travel Requirements:

Driving:  50%

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

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Pay Range: $24 - $56.17 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.