R&E Nurse- Med Care Services (756721)

Minimum Qualifications

• Current and valid Pennsylvania Registered Nurse License
• Minimum two (2) years clinical expertise of physical disabilities, medical conditions, and treatment modalities.
• Minimum one (1) year quality improvement experience in multifaceted formal quality management program
• Computer expertise including a working knowledge of word processing functions, as well as data base utilization, maintenance, and management.

Role Description

This position is in the Critical Incident Management Unit, Division of Participant Supports, Bureau of Coordinated and Integrated Services within the Office of Long-Term Living (OLTL). The incumbent is assigned to a team tasked (1) to ensure that quality, effective, and efficient Home and Community-Based Services (HCBS) are provided to participants in their communities (through the Community Health Choices waiver -CHC- and Fee for Service -FFS- programs); (2) to ensure that events that resulted in risk to the participants health, safety, and welfare are reported and investigated according to agency policies and procedures; (3) to ensure all Unit activities are aligned with the Money Follows the Person’s (MFP) initiatives.

Description of Duties

Review Enterprise Incident Management (EIM) incidents reports daily.

Complete mortality reviews and the necessary follow up by:

· Identifying potential causes of death or circumstances that may lead to death.

· Conducting initial screenings for factors that require further investigation.

· Forwarding mortality review (MR) template to include request for applicable supporting documentation to Service Coordinator (SC) or Managed Care Organization (MCO) for completion.

· Tracking receipt of completed MR template and additional documentation from SC/MCO.

· Requesting information from Adult Protective Services/Older Adult Protective Services, when applicable.

· Requesting PA Department of Health death data.

· Utilizing PA Department of Health death data to compile a findings summary statement [with program recommendations, when indicated], and present to Medical Director for review.

· Presenting mortality cases to the Mortality Review Team (MRT).

· Identifying issues and recommend changes in practice or policy.

· Recommending program mitigation strategies.

· Providing recommendations to Providers, SCs, and MCOs regarding risk mitigation, delivery of services, best practices, quality of care, or additional training or education.

· Recommending cases to State MRT committee.

· Reviewing aggregate data over time to identify trends.

· Reviewing comprehensive annual mortality review.

· Completing appropriate follow-up activities:

· develop a response to cases that may have had poor quality of care, neglect or abuse as a factor contributing to death

· refer to the county’s District Attorney or the Attorney General

· develop and issue Provider outcome measures: Statement of Findings (SOF), Medical Director Recommendations (MDR), Recommendation for Improvement (RFI)

As needed, represent OLTL at hearings and appeals related to reportable incidents or service plans for HCBS and/or assist in the research required to prepare for hearings and appeals.

As needed, travel to meet with providers or other agencies.

Perform other related duties as assigned by supervisor.

Essential Functions

1. Possess current Pennsylvania Registered Nurse (RN) License

2. Be knowledgeable of medical conditions and terminology.

3. Be knowledgeable of physical disabilities, associated limitations to Activities of Daily Living (ADLs), Instrumental ADLs, and relevant supports.

4. Understand OLTL Medicaid Waivers and Act 150 program, regulations, policies, and procedures.

5. Be technology-savvy and able to work remotely using videoconference and telephonic platforms.

6. Ability to work independently, self-initiator.

7. Organize and deliver presentations.

8. Be able to prioritize tasks.

9. Be able to explain programmatic requirements to participants, providers, and other stakeholders.

10. Be able to effectively communicate both orally and in writing.

11. Understand and interpret local, federal, and state laws as relevant.

12. Possess working knowledge of or advanced ability to learn Microsoft Office suite, Home and Community Services Information System (HCSIS), WellSky, and Client information system (CIS/e-CIS).

Travel independently with overnight stays, without available public transportation

About Us:

TulaRay partners with clients to create staffing solutions that meet unique organizational needs. Our services are designed to reduce administrative burdens, protect your brand, and improve assignment time-to-fill. We believe that mutually successful client relationships are built on lasting quality and exceptional customer service. We pride ourselves on our uncompromising commitment to high-quality emergency management & healthcare personnel, while ensuring that our clients are taken care of with personalized attention. TulaRay manages total compliance and respectfully supports hundreds of professionals and patient-centered programs.

TulaRay is proud to be an affirmative action employer and is committed to providing equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. If you have a disability or special need that requires accommodation, please let us know by visiting our website at tularay.com