Field nurse job description

**$5,000.00 sign on Bonus for External candidates**

What you do matters. And who you do it for matters even more. If you're looking for more meaningful impact, you should take a serious look at our growing organization. Since our founding in the mid-90's, Peoples Health has brought innovation and compassion to Medicare patients throughout Louisiana. Now, part of the UnitedHealth Group family of companies, our team consists of over 900 people who are experienced in all aspects of care delivery, health maintenance and administrative support. It's our goal to help guide over 60,000 Medicare recipients across the broad spectrum of health and dental services. We're committed to the highest purpose; improving lives. And that makes us the singular place to do **your life's best work.(sm)**

The Nurse Practitioner holds primary responsibility to conduct clinical assessment(s) of PH members, documents and codes encounters in the authorized electronic medical record system(s), in an effort to improve our plan member's quality of life and to facilitate optimal health outcomes through cost-effective healthcare. The NP reports to the NP Manager.

**Primary Responsibilities:**

+ Conduct assessments in a variety of settings on health plan members, including past medical history, review of symptoms, physical examination, medication review and depression screening

+ Responsible for checking vitals, conducting a physical exam that includes monofilament test and foot exam (as appropriate)

+ Identify diagnoses to be used in care management and active medical management in the furtherance of treatment

+ Formulate a list of current and past medical conditions using clinical knowledge and judgment and the findings of your assessment

+ Communicate findings in your assessment that will be used to inform the PCP of potential gaps in care

+ Educate members on topics such as disease process, medication and compliance

+ Comply with all HIPAA regulations and maintain security of protected health information (PHI)

+ Since all jobs may involve in-home visits, the ability to work autonomously and extensive travel will be required. You should also be comfortable working with geriatric patients who have a variety of health complications

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

**Required Qualifications:**

+ Active, unencumbered license to practice nursing in the assigned state

+ Nurse Practitioner Certification from either the ANCC, AANP or AACN as Adult, Geriatric, Family or Acute Care NP

+ 1+ years of clinical experience in highest level of education OR 3+ years of experience as a Registered Nurse

+ Access to reliable transportation that will enable you to travel to client and/or patient sites within a designated area

+ Ability to obtain prescriptive authority post-hire in states where applicable

+ Ability to spend at least 1 hour with a member in their home, if applicable, which may be in remote areas, in the presence of pets or individuals who are tobacco users

+ Ability to lift a 30-pound bag in and out of car and to navigate stairs and a variety of dwelling conditions and configurations

+ Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

**Preferred Qualifications:**

+ Experience in Gerontology, Cardiology, Internal Medicine, Endocrinology or Family Medicine

+ Home care or home visit experience

+ Excellent administrative and organizational skills and the ability to effectively communicate with seniors and their families

+ Computer literate and able to navigate the internet

_To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment_

**Careers at UnitedHealthcare Medicare & Retirement.** The Boomer generation is the fastest growing market segment in health care. And we are the largest business in the nation dedicated to serving their unique health and well-being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You'll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our health care system. Ready? It's time to do **your life's best work.(sm)**

_Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law._

_UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._

Remote position with Travel to do on-site audits. (M-F 8/8:30 AM to 5/5:30 PM PST) with flexibility for night and weekends to meet audit deadlines

Travel would be in Southern California Los Angeles, San Bernardino, Riverside, San Diego, Imperial, Orange, Sacramento

For this position we are seeking a (RN or LVN) with previous experience Utilization Management or NCQA accreditation knowledge of Interqual / MCG guidelines. Excellent computer multi-tasking skills and analytical thought process is important to be successful in this role. Productivity is important with turnaround times. Experience with UM Audits will be very important to be successful in this role. Further details to be discussed during our interview process.
JOB DESCRIPTION

Job Summary

Responsible for continuous quality improvements within the Delegation Oversight Department. Oversees delegated activities to ensure compliance primarily with NCQA, CMS and State Medicaid requirements including delegation standards and requirements contained in the delegation agreement.

KNOWLEDGE/SKILLS/ABILITIES

The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM delegates are compliant all applicable State, CMS, and NCQA requirements, as well as Molina Healthcare business needs. In addition, the Delegation Oversight Nurse will assist the Delegation Oversight Manager with additional duties of the team. This includes, but is not limited to:

+ Coordinates, conducts, and documents pre-delegation and annual assessments as necessary to comply with state, federal, NCQA, and any other applicable requirements.

+ Distributes audit results letters, follow up letters, audit tools, and annual reporting requirement as needed.

+ Works with Delegation Oversight Analyst on monitoring of performance reports from delegated entities.

+ Develops corrective action plans when deficiencies are identified, and documents follow up to completion.

+ Assists with meetings of the Delegation Oversight Committee.

+ Works with the Delegation Oversight Manager to develop and maintain delegation assessment tools, policies, and reporting templates.

+ Assists with preparation of delegation summary reports submitted to the EQIC and/or UM Committees.

+ Participates as needed in Joint Operation Committees (JOC's) for delegated groups.

+ Assists in preparation of documents for CMS, State Medicaid, NCQA, and/or other regulatory audits as needed.

JOB QUALIFICATIONS

Required Education

Completion of an accredited Licensed Vocational Nurse (LVN), or Licensed Practical Nurse (LPN) Program

Required Experience

+ Minimum two years Utilization Review experience.

+ Knowledge of audit processes and applicable state and federal regulations.

Required License, Certification, Association

Active, unrestricted State Licensed Vocational Nurse or Licensed Practical Nurse in good standing.

Preferred Education

Completion of an accredited Registered Nurse (RN) Program or a bachelor's degree in Nursing.

Preferred Experience

+ Three-year NCQA, CMS, and/or state Medicaid UM auditing experience.

+ Three years' experience in delegation oversight process and working knowledge of state and federal regulations.

Preferred License, Certification, Association

+ Active and unrestricted Certified Clinical Coder

+ Certified Medical Audit Specialists (CMAS)

+ Certified Case Manager (CCM)

+ Certified Professional Healthcare Management (CPHM) Certified Professional in Health Care Quality (CPHQ)

+ or other healthcare

+ or management certification

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.

ACS Solutions has an immediate need for a Field Nurse with experience in the Medical/Healthcare Industry. This is a 2-month contract (Possible extension) and is in Buffalo, NY. Our client is a Medical Insurance Provider company.
Please review the job description below:

Top Skills:

Valid NYS Nursing Licensure

Drivers License

Clinical Experience

Key Responsibilities

This position is responsible conducting face to face assessment of members in their home and/or facility. This is accomplished by utilizing required NYS UAS Assessment Tools to determine functional status, medical, behavioral, psychological, and community resource needs for coordinating, integrating, and monitoring the use of medical and health care services for members; The SN UAS Nurse may also perform other technical and administrative tasks essential to the efficient operation of the department.

Essential Responsibilities / Accountabilities:

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 member's 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 -

o Identifies, recommends and assesses new processes as necessary to improve productivity and gain efficiencies.

o 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.

Minimum Resource Qualifications:

RN with valid and current NYS Nursing Licensure
Valid NYS driver's license required
A minimum of four years clinical experience in ambulatory care, community health or home health setting
Long Term Support Services (LTSS) or Managed Long-Term Care (MLTC) UAS field RN experience preferred.
Excellent written and verbal communication skills.
Excellent computer skills and use of measurement/criteria following NYS guidelines.
Working knowledge of Microsoft Office applications (Word, Excel)
Strong interpersonal skills.
Understanding of the basic Utilizations Management aspects of the department
Provide efficient, effective, and appropriate documentation
Ability to take on broader responsibilities
May be asked to participate in some committees
Broad understanding of multiple areas, including but not limited to UM and CM, Fair Hearings and Appeals/Grievances, within three months of working in position.
Demonstrates ability to handle complex assignments, difficult members and highly visible issues.
Must have ability to travel.

Thanks and regards,

GARV BHALLA

Sr. Associate‑ Recruitment

ABOUT ACS Solutions.

ACS Solutions is a global provider of information technology solutions, talent solutions and workforce management services. Our Industry vertical based domain expertise, passion for innovation, combined with the power of technologies in cognitive sciences, cloud computing, data sciences, product engineering, robotic process automation, machine learning, and block chain, helps clients envision, build and run their businesses more efficiently. Headquartered in the US, ACS Solutions has grown to over $1.2 BN.

ACS Solutions is a Certified MBE by the Georgia National Minority Supplier Development Council.

ACS solutions has multiple subsidiaries, each focused on the unique area of business:

Analysts international Corporation (Staff Augmentation Services)
The Ascent Services Group Inc. (Life Sciences Talent Solutions)
HireGenics, (Payrolling, IC Compliance, & MSP Services)
DATA Inc. (Information Technology- staffing)

Recent Awards and Recognitions:

6th largest IT staffing firm in the US. (Staffing Industry Analysts (SIA) 2019)
Largest Minority IT Staffing Firm in the US. (SIA 2019)
ClearlyRated 2020 Best of Staffing award winner for providing remarkable service quality to our clients. This is our ninth consecutive win.

IT and Industry certifications:

Microsoft Gold Partner: Application Development, Cloud Platform, Data Analytics, Data Center, DevOps, Data Platform
AWS Managed Services Partner
Google Cloud Partner
ISO 27001:2013 Certified for Data Security
ISTQB Gold Partner
ISMS (ISO 27001:2017)
SOC2 Type II Compliant