What are the responsibilities and job description for the Field Nurse position at PSG Global Solutions Careers?
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The Opportunity
Description
We're looking for a Field Nurse , working in Insurance industry in Syracuse .
- Conducts face to face assessment of members utilizing required NYS UAS Assessment Tools, and / or other tools as directed by NYS or other regulatory bodies, to determine functional status, medical, behavioral, psychological, and community resource needs, as well as members level of work capacity and related restrictions / limitations.
- Collaborates with interdepartmental teams and external stakeholders, if necessary, to assist in the development of Person-Centered Service Plan; Clarifies benefits, policies, and procedures for current members, providers, and community-based agencies.
- Assesses, plans and implements care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care.
- Identifies social service programs; including financial, psychosocial, community and state supportive services available to augment the need for LTSS services.
- Refers appropriate cases to governmental agencies (e.g. APS / CPS) as needed, and any suspected / possible Medicaid fraud to the Special Investigations Unit (SIU) or designated internal / external entity.
- Communicates with all internal and external stakeholders to obtain the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
- May be required to attend Fair Hearings with Medical Director relating to specific cases.
- Attends departmental meetings, as required.
- Works independently, as well as collaboratively, with members and internal / external stakeholders, resulting in improved member health.
- Manages complex assignments.
- Serves as a positive role model to others in the department.
- Adheres to all Corporate and Departmental policies and ensures all regulatory requirements such as DOH, CMS, Medicaid, and accreditation requirements such as NCQA, URAC and HEDIS functionalities are met or exceeded.
- Process Management and Documentation -
- Identifies, recommends and assesses new processes as necessary to improve productivity and gain efficiencies.
- Assists in updated departmental policies, procedures and desk-top manuals relative to their function.
- Serves as subject matter expert and if called upon, works directly with the operation and clinical staff to resolve issues and escalated problems.
- Acts as informational resource to other departments, staff, members and providers.
- Responsible to assist with workflow coordination within the department.
- Assists manager or director with projects.
- Mentors other staff & assists with coaching when necessary.
Our Client
Our client is a fast-growing industry-recognized staffing firm. Recruiting critical IT, Financial, Engineering, Healthcare, and Data Analytics talent. With 20 years' experience and growth.
Connections in Automotive, Healthcare, Retail, Financial & Insurance, and Professional & Business Services. Working to bring top talent together with premier organizations.
Big enough to have great opportunities. Small enough to care about finding the right one for you.
It'sabout relationships based on mutual interest. The results are low turnover, long-lasting partnerships and growth. Want to work for a company invested in your success?
Experience Required for Your Success
What Do You Think?
Does your experience reflect what it takes to be successful in this role? Do the work and challenges get you excited about what's possible?