Manager of Nursing

Elderwood Health Plan has a new and rewarding clinical opportunity for a Director of Clinical Navigation and Analytics (RN). 

RN - Director of Clinical Navigation and Analytics for Elderwood Health Plan - Overview:

The Director of Clinical Navigation and Analytics (RN) will ensure effective and efficient completion of tasks associated with the clinical assessment process including but not limited to clinical onboarding, UAS-NY and NYIA assessment review, risk score review, and post-hospital discharge evaluation. The Director of Nursing serves as a valuable resource to the Care Management team by documenting critical clinical caseloads, reassessments, and change in condition information in the electronic record system. The Director of Nursing partners with the Social Work team to facilitate the MLTC care model by coordinating services and community resources and meeting member socioeconomic needs to support the quality of life.

Elderwood Health Plan Overview:

Director of Clinical Navigation and Analytics

1. Assist the Director of Clnical Operations in planning, developing, organizing, implementing, evaluating, and directing the day-to-day functions of the Care Management Department
2. Makes written and oral reports/recommendations to the Director of Clinical Operations as necessary/required, concerning the operation of the Care Management department.
3. Manages a team of clinical assessment nurses and reviewers to ensure the seamless and timely completion and quality of assessments while also focusing on the data analytics including risk score, gaps in care, and utilization.
4. Responsible for UAS-NY and NYIAP oversight for Elderwood Health Plan
5. Monitor clinical and business dashboards/metrics that drive patient outcomes and performance metrics as it relates to their team's performance.
6. Participate in the utilization review process and evaluate to determine if the member’s condition and needs meet criteria for covered services and provide service prior authorization or denials to health care providers.
7. Collaborates with Care Management Team to improve performance in areas of Quality, Risk Adjustment and Operations
8. Assess the on-going learning needs of employees to meet the needs of the individuals, the organization, and the employees.
9. Delivers member specific metrics and coaches RNs on gap closing opportunities.
10. Develops processes, policies, and workflows necessary to meet KPI’s and business goals
11. Compare re-assessment data to baseline assessment to monitor Members’ progress, recognize alterations in function, including life-threatening situations, and intervene and document appropriately.
12. Serves as clinical point person in response to Care Delivery questions, concerns, or issues
13. Ensure that documentation in the care management record meets all applicable professional standards, using an EMR for each observation, verbal report, or interaction with the Member, Member’s caregiver/family, PCP or other provider, whether by home visit, telephonic, or written interaction.
14. Participate in Disease Management, Utilization Management, and Quality Improvement activities.
15. Perform other related duties and responsibilities as directed.

Director of Clinical Navigation and Analytics

Licensure:  At minimum, a current New York State Registered Nurse License and a valid NYS Driver’s license.

Education: BSN, AAS Degree or diploma in Nursing and Case Management Certification is preferred.

Required Experience:

• Minimum of five (5) years nursing experience in home care, case management, discharge planning or managed care.
• Minimum of three (3) years management experience
• Minimum of one (1) year experience working with a frail or elderly population.
• Minimum of one (1) year experience with health assessments.

Additional Requirements:

• Must have a safe driving record and dependable car, as well as willingness to travel throughout the EHP service area. A DMV motor vehicle report will be reviewed.
• Must be in good standing with the Medicare and Medicaid programs. This includes a criminal background check.
• Must be free of communicable disease.
• Bilingual skills are preferred, but not required.