R&E Nurse- Med Care Services (775764)

Minimum Qualifications:

Possession of a current license to practice as a Registered Nurse issued by the Pennsylvania State Board of Nursing; or Possession of a non-renewable temporary practice permit issued by the Pennsylvania State Board of Nursing. Resources possessing non-renewable temporary practice permits must obtain licensure as a Registered Nurse within the one-year period as defined by the Pennsylvania State Board of Nursing.
Proficient writing and basic Computer Skills to include, but not limited to, Microsoft Office Products
Three years of professional experience with medical assistance (MA), health care services, or human services
Minimum of three years of recent (within the last five years) professional experience in one or more of the following areas as related to the position need: long term care, acute care setting, behavioral health setting, drug and alcohol setting, managed care, quality management/utilization review or other related clinical experience; or
An equivalent combination of experience and training in the field of medical assistance (MA), health care services, human services, long term care, utilization review, or knowledge of home care
Knowledge of and familiarity with the following would be beneficial: Inter- Qual criteria, ICD-9 CM, and current procedure terminology,
Ability to use professional judgment in identifying aberrant patterns and determining the appropriate action to be taken following the documentation review.

Description of Duties:

Assess and review reportable incidents and service plans for participants receiving HCBS through various programs. Ensure individuals are eligible, that service plans are appropriate, and that services are delivered as defined in the service plans. Work with Adult Protective Services, Older Adult Protective Services, and other agencies inside and outside of the Department of Human Services on critical incident management. This responsibility includes ensuring the health and well-being of the participant, adhering to response timeframes in accordance with OLTL regulations, policies, and program requirements, providing technical assistance and seeking clarification on reportable incidents. Review and evaluate medical documentation to determine whether HCBS are appropriate and if not refer the matter to the appropriate agency for action. Work with social workers in deciding whether potential informal and formal supports are sufficient to maintain the individual in their home with regard to the use of available resources. Review critical incident reports identifying patterns and trends that impact participants' service plans. Confer with Department physician consultants on individual cases as necessary.

A main function of the incumbent will be to conduct Mortality Reviews on critical incident reports to determine if the death occurred as a result of negligent practices, and if further investigation is required based on the review of reported cause of death as well as the review of available documentation of circumstances surrounding the death, and HCBS the participant was receiving at the time of death. Mortality Reviews are also an integral part of trends analyses and best practices that can assist in death prevention. The incumbent will also assist in evaluation and monitoring of the existing HCBS programs and the development of new HCBS initiatives. This responsibility requires a thorough knowledge of HCBS as alternatives to institutional placement. Assist other team members in the unit in the day-to-day operations of all OLTL HCBS programs. Review policies, procedures, and standards in HCBS programs to ensure that programs are operating accurately, effectively, and efficiently and that the services are meeting consumers' needs. Gather relevant information and respond on behalf of OLTL to inquiries/concerns of legislators, stakeholders, agencies, physicians, and others. Provide instruction on OLTL HCBS policies and procedures to individuals, families, agencies, physicians, and providers.

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. Performs other related duties as necessary.

Decision Making

Working within a team, the incumbent will review reportable incidents and service plans and determine an appropriate response in accordance with OLTL regulations, policies, and waiver requirements. Incumbent independently determines the appropriateness of service plans and services provided. The incumbent will represent the OLTL in individual and group settings providing information and determinations to legislators, stakeholders, providers, and others.

Essential Functions

1. Possess current Pennsylvania Registered Nurse (RN) Certification

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. The Critical Incident Management Team is currently on part time teleworking status.

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 Microsoft Office suite, Home and Community Services Information System (HCSIS), WellSky, and Client information system (CIS/e-CIS).

13. 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