Field Nurse Evaluator (Kingston, NY)

Description & Requirements

Maximus is currently hiring for a Field Registered Nurse - Home Care to support our C-YES Program.

(Children and Youth Evaluation Services).

This is a full time, hybrid-remote position that will require travel throughout territories of Kingston, Oneonta, Newburgh, and Middletown, New York.

Maximus has partnered with the New York State Department of Health to establish the Children and Youth Evaluation Service (CYES) program to determine whether a child or youth is eligible for home and community-based services (HCBS) covered by Medicaid.

The Field Nurse Evaluator will be working in the community conducting strength-based assessments for families who have children (ages 0-21) with behavioral health/psychiatric issues.

All nurses are provided support and education for ongoing professional development and annual certification in the CANS-NY assessment tool.

The assessments will be the basis for family-driven Plan of Care (POC) development to support the family's access to Home and Community Based Services (HCBS).

The Nurse Evaluator will conduct 1-2 assessments a day and work with a Family Support Coordinator to meet the family's case management needs specifically related to the HCBS POC.

Essential Duties and Responsibilities:

- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.

- Render medical necessity determinations for cases assigned.

- Resolve all other technical issues within reconsideration assigned.

- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.

- Perform other duties as assigned by management.

- Develop Home and Community Based Services (HCBS) Plan of Care (POC) in collaboration with child and family that includes evaluation of health status.

- Perform initial in-home evaluations of children that includes evaluation of health status, strengths, care needs, and preferences and guide the development of individualized long-term care service plans.

- Review child's medical documentation and or health referral forms, as relevant to the case

- Utilize the State CANS assessment tool and MAXIMUS case management systems to document the child's health status, strengths, care needs, diagnoses and preferences and transmit, as required.

- Properly document any concerns, conflicting information, other issues that surface during the evaluation process

- Emphasize continuity of care, thus reducing or eliminating fragmentation, duplication, and gaps in treatment plan

- Discuss with child/family health care options, supports needed, service vendor options and waiver options.

- Update plans of care as per State requirements, and on an as needed basis

- Collaborate with Family Support ...