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Identifies and coordinates enrollee services as provided by the plan and services that are not a benefit of the plan (Medicare Services).
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Completes comprehensive assessment using the DOH approved tool to determine eligibility of medically necessary services.
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Educates and completes with enrollee all necessary consents and documentation.
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Initiates and carries out continuous assessment of physical, emotional, social, cultural, economic, and environmental needs of the enrollee and coordinates services for needs as determined.
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Observes the enrollee for changes in condition and follows up with appropriate services or providers to attempt to prevent disease exacerbations.
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Develops, monitors and revises a Plan of Care with the enrollee or enrollee’s designee that has problem, enrollee centered goals and interventions.
- Implements orders for Durable Medical Equipment items and treatments as prescribed by the physician, submitting and maintaining appropriate medical orders and documentation.
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Completes documentation per company standards/policy utilizing an Electronic Medical Record (EMR) system.
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Participates in Marketing Activities as requested by Executive Director or Designee.
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Accepts assignments and performs duties within their nursing scope of practice, seeking and obtaining sufficient information/education necessary to function effectively in the managed long term care setting.
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Participates in departmental and organizational committees and meetings as applicable.
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Participates in the orientation of new staff, mentors peers, and promotes collaborative teamwork.
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Performs all duties and responsibilities in accordance with the Nurse Practice Act and in accordance with the basic principles of professional nursing.
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Maintains a working knowledge of, and adheres to applicable federal/state regulations including, but not limited to, patient confidentiality, release of information, and HIPAA.
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Performs other related duties as requested by the Executive Director or Clinical Services Manager.
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Clarifies issues and actively addresses concerns in a timely manner.
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Ability to manage conflict, stress, and multiple simultaneous work demands in an effective, professional manner.
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Ability and willingness to self-motivate, prioritize, and be willing to change processes to improve effectiveness efficiency. Adapts to changing enrollee or organizational priorities.
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Ability to make independent decisions in accordance with established policies and procedures.
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Performs related duties as assigned.