Advance Care Alliance (ACANY) is seeking a qualified nurse to join a regional clinical services team, comprised of social workers, licensed mental health professionals, and nurses. The clinical services team works closely with the ACANY care management team to:
- Integrate services and supports, with a goal of ensuring that social determinants of health, community dynamics, and health (behavioral, mental, and physical) are addressed and people receiving care management services have plans that effectively meet their needs;
- Interface with community supports, like hospitals, behavioral health IPAs, and NYS START programs, to intervene where appropriate to support emerging and predicted population needs;
- Train the care management team on a variety of health related topics and offering immediate support to the care management team in navigating the various and sometimes disparate health systems.
ACANY is a 501(c)(3) organization that has received initial designation as a Care Coordination Organization/Health Home (CCO) from New York State. CCO is an emerging care management model for people with I/DD that replaces Medicaid service coordination (MSC) to provide enhanced care management to qualified people. The organization's initial priority is to support a smooth transition to this enhanced service model for people with I/DD and their families. ACANY anticipates enrolling 25,000+ people in its program and will draw Care Managers from 100+ member organizations spanning New York City, Long Island, and the Lower Hudson Valley.
- Review case specific information and consult with to care managers to ensure coordinated services and provide clinical recommendations to enhance service delivery;
- In partnership with the care coordination team, provide training and information to individuals and family members, to promote health and well being, mitigate risk factors and ensure ongoing support;
- Educate individuals and family members on diagnoses, health conditions and medications;
- Liaise with community providers and state agencies, to identify appropriate referral options and facilitate timely connection to services;
- Interface with the Training and Quality Assurance departments to identify and, at times, deliver training content to improve the capacity of the care management staff;
- Provide discharge planning assistance to care managers, and attend discharge conferences when appropriate, to support the care manager and family and ensure the plan is in the best interest of the individual;
- Under the supervision of the director, monitor quality of care outcomes that contribute to overall team performance in achieving desired clinical and operational performance measures.
- Assist care managers with the interpretation of assessments and screening tools, recommend additional screening or assessment when appropriate, and facilitate access to preventive health screenings.
- In partnership with care managers, assess safety concerns in an individual's environment to promote accessibility and mobility, as well as to provide instruction in patient safety.
- Register Nurse or LPN, with two years' experience in behavioral health, medical, and/or mental health services;
- Working knowledge of working and understanding of the needs of individuals with I/DD;
- Experience providing direct service and intervention to individuals in the community, preferably with some experience in crisis services, substance abuse treatment, or continuity of community health supports;
- Willing to travel as required for the position. Travel time may exceed one hour.
- Absolute sense of integrity and personal commitment to serving people with I/DD and their families;
- Excellent interpersonal, public speaking, and written communication skills;
- Ability to work autonomously;
- Demonstrated leadership abilities;
- High level of professionalism, respect and ability to work in a team environment.
Associated topics: ambulatory, ccu, nurse clinical, psychatric, recovery, registered nurse, surgery, surgical, tcu, unit