One of New York’s largest not-for-profit health insurers offering over 2 million members access to high-quality, affordable healthcare is seeking Registered Nurses (RN) to join their team. Their goal is to help members navigate the healthcare system and foster healthier communities by partnering with providers and community organizations to advance health equity and value-based care.

Conducts home and virtual assessments for prospective members and re-assessments of current members using the Uniform Assessment System (UAS); make enrollment and continued eligibility determinations by utilizing clinical expertise and critical thinking skills.

• Conducts two-member home assessments daily for prospective members and re-assessments of current members using the Uniform Assessment System (UAS); make enrollment and continued eligibility determinations by utilizing clinical expertise and critical thinking skills.  As needed, conducts assessments in settings other than home as needed, e.g. skilled nursing facilities or virtually
• Navigates multiple technology/digital platforms such as UAS software, electronic medical records, TruCare, to conduct and document comprehensive assessments accurately and efficiently 
• Completes assessment of service needs per CMT and member's family/caregiver’s request to determine service needs or any necessary adjustments
• Reviews previous nursing assessments/medical notes to determine necessary adjustments/updates in Care Plan and/or to assist with nursing home admission
• Conducts in-person Care Management visits in support of person-centered service planning
• Liaisons between the member and the Care Managment Team; assesses home environment and psychosocial status
• Provides feedback to home care agencies and CMT regarding home care issues and contract nurses and aides performance
• Provides grass roots, community-based training for frail population care including self-care techniques and prevention strategies
• Ensures (prospective) members and significant others/responsible parties understand and agree with enrollment in a managed long-term care plan
• Additional duties as assigned

• New York State RN license
• ASN or BSN degree
• Ability to travel for field nursing to selected boroughs via public transportation or vehicle with a NYS Driver's License
• Must be comfortable going into NYCHA housing, nursing home, shelter and projects
• Must have a great understanding of the chronic health conditions (hypertension, diabetes, respiratory issues and COPD) with the population
• Experience working with a frail adult or elderly population with the ability to determine appropriate care plans and services for frail population as well as negotiate initial service plans so that members and families are in agreement
• Previous field-based experience assessing, planning, and evaluating member's care by making home or facility visits for intake/reassessments or start of care (SOC) Community Home Health Agency (CHHA) visits 
• RN Grads and experienced RNs with prior experience as a HHA, Personal Care Aide (PCA),  PCT, EMT, or Social Workers are an excellent match for Field Assessment Nurse and Hybrid Assessment RN roles
• Prior work experience requiring technological proficiency including the ability to navigate multiple technology platforms and modalities - MS applications, Excel especially, Outlook calendar, Zoom and Teams
• Work experience preferred in one or more of the following areas: geriatrics, home care, discharge planning, case management, and/or medical surgical nursing
• Knowledge of health insurance, Medicaid, Medicare and MLTCP
• Time management, critical/creative thinking, communication, and problem-solving skills