MAJOR POSITION DUTIES AND RESPONSIBILITIES:
The incumbent will be assigned to the Office of Long-Term Living (OLTL) Division of Participants Supports within the Bureau of Coordinated and Integrated Services and will be tasked as follows.
Must be licensed a Registered Nurse.
As a member of a team, the incumbent will primarily be responsible for the clinical review of critical incidents for participants receiving home and community-based services through the Act 150 program and OBRA and Community Health Choices (CHC) waivers.
The incumbent will provide support and technical assistance on an array of home and community-based services available to older Pennsylvanians and persons with physical disabilities.
The incumbent will provide clinical guidance in developing an effective plan to identify and address short and long-term risks to participants.
The incumbent will also assist with reviewing long-term living supports and services for participants as well as assist with the completion and analysis of Mortality Reviews.
Review electronically submitted critical incidents to ensure they are appropriate and that the participants’ health and safety needs and services are delivered as defined in the plans. As necessary, seek additional functional or medical information from the agency submitting the critical incident to provide technical assistance and clarification in plan development in accordance with OLTL regulations, policies and waiver requirements. Timeliness of critical incidents reviews and Registered Nurse consultation is critical to participant’s health and well-being and should be completed within established timeframes in accordance with OLTL regulations.
Respond orally and in writing to both basic and medically complex inquiries within a reasonable timeframe regarding home and community-based programs.
Prepare responses to legislative inquiries for review by supervisor.
Investigate incidents involving participant’s health and welfare as well as complaints received from participants, service coordinators or supervisors and provide resolution, seeking supervision when necessary.
Use established precedent and policy to provide functional and clinical guidance, consultation, technical assistance, to enrollment brokers, service coordinators applicants and caregivers; advise supervisor of problems and/or medically complex issues as appropriate.
Identify any operational issues which impede the provision of appropriate, cost-efficient services to individuals and recommend remedies/necessary changes to supervisor.
As a member of a team or Division group, participate in developing/revising OLTL home and community-based program policies and procedures with clinical input.
Prepare detailed analysis and summary of current health and safety issues, service plan trends, or other statistical data both to support projects as well as on-going management of the program.
Participate in developing and presenting training to Division staff, other OLTL staff, key constituents and providers.
Serve on workgroups comprised of staff from within OLTL or stakeholders from outside OLTL.
Committee work may include: preparing Medicaid waiver amendments and renewals; evaluating policy recommendations, directives and regulations; and assisting with the development of operational manuals, program directives, work plans, system changes, regulations, policies and procedures to ensure that home and community-based waiver and community programs are administered accurately, effectively and efficiently and that services meet participant needs.
Draft responses to programmatic and clinical reviews of service provider agencies conducted by staff from other bureaus, or reviews by federal oversight agencies such as Centers for Medicare and Medicaid Services (CMS).
Work may include the development of written work plans to remediate particular findings in such reviews.
As needed, accompany team member(s) on field travel to provide on-site technical/clinical support, re-mediation, and problem-solving to participants, families, providers and other key stakeholders.
Attend and participate in team meetings, division and bureau meetings as scheduled.
Participate in hearings as requested by the DHS Bureau of Hearings and Appeals.
Assists participants to receive managed care long term services and supports that ensure their health and safety in receiving services in their home and community.
Perform other related duties as required.
*OLTL will consider full-time & part-time candidates that can provide a minimum of 15 hours per week for this remote requisition.*
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