Nurse Assessor

• Conduct in-home evaluations to develop personalized long-term care plans
• Perform initial in-home pre-evaluation of patients that includes evaluation of health status, strengths, care needs, and preferences and guides the development of individualized long term care service plans
• Review medical documentation and enter data into the system
• Review consumer medical documentation and/or health referral forms, as relevant to the case
• Facilitate communication between care teams and ensure seamless care coordination
• Identify health promotion opportunities and advocate for preventive care
• Maintain a thorough understanding of community resources and payor requirements
• Enter evaluation data into electronic evaluation form and transmit, as required
• Document any concerns, conflicting information, other issues that surface during the evaluation process
• Emphasize continuity of care, thus reducing or eliminating fragmentation, duplication, and gaps in treatment plan
• Discuss with consumer health care options, supports needed, service vendor options and waiver options
• Initiate communication between the Call Center and eligible consumers for enrollment into a managed care health plan
• Enhance communication and collaborative relationships with interdisciplinary care team members to improve care coordination and facilitate service delivery
• Collect quality review data and any required documentation to support outcome measurements and record case notes into the customer relationship manager system
• Identify opportunities for health promotion and consumer illness prevention
• Maintain a comprehensive working knowledge of community resources, payor requirements, and network services for target population
• Meets all the standards established for this position as outlined in the corresponding annual performance criteria and bonus template for this position
• Performs other duties as may be assigned by the Regional Nurse Manager or other project management

• Graduate of an accredited nursing program
• BSN preferred
• Current RN Licensure in New York State
• At least 2 years of experience in a home setting
• Proficient in health status evaluations
• Adept with technology
• Knowledgeable in nursing practices and state regulations
• Strong organizational, interpersonal, and communication skills
• Ability to work effectively with a diverse, multi-generational population
• Independent, self-starter who thrives in a fast-paced environment
• Must have a valid NY State Driver's License or ID
• Willing to travel for onsite assessments

Bilingual Skills: Preferred in languages such as Spanish, Russian, Haitian-Creole, Chinese, or Korean

• Hybrid Work Environment: Enjoy a flexible schedule with a mix of telehealth and in-home patient assessments
• Impactful Work: Play a crucial role in evaluating and guiding patients to the care they need
• Comprehensive Training: Orientation and training conducted remotely to set you up for success
• Medical, dental, and vision coverage
• Life and disability insurance
• Additional voluntary benefits