Quality Assurance Nurse Specialist (Hybrid/Remote)

General information

Job Posting Title Quality Assurance Nurse Specialist (Hybrid / Remote) Date Monday, July 8, 2024 City New York State NY Country United States Working time Full-time

Description & Requirements

Maximus is seeking a dynamic Quality Assurance Nurse Specialist to join the Children and Youth Evaluation Service (C-YES) program.

Although this position is hybrid / remote, applicants must reside in either New York or New Jersey to qualify.Maximus collaborates with the New York State Department of Health to run the Children and Youth Evaluation Service (CYES) program.

This program determines eligibility for Medicaid's home and community-based services (HCBS) for children and youth aged 0-21 who are identified as Medically Fragile (MDF) or having Serious Emotional Disturbance (SED).

The QA Nurse Specialist is responsible for implementing CYES Quality Assurance practices, conducting peer reviews, and identifying trends to deliver targeted education and ensure high standards of service delivery.

Essential Duties and Responsibilities :

• Collaborate with the Quality Assurance Nurse Manager to develop an effective quality monitoring program
• Provide QA training to the Nurse Assessors, RN Monitors, and the QA staff in order that quality actions are incorporated into their daily practice
• Collect data related to assessments and assessment outcomes
• Examine cases at random for completeness, accuracy and consistency
• Examines data for outliers and researches such cases
• Analyze UAS recommended scores in relation to Nurse Assessor determinations
• Develops / completes reports that track and trend activities / outcomes
• Acts as an advisor to UAS staff on all QA and Compliance issues related to the UAS project.
• Attend Fair Hearing cases and prepare case packets, as required
• Frequent travel is required
• Meets all standards established for this position as outlined in the corresponding annual performance criteria and bonus template for this position
• Performs other duties as may be assigned by Management
• Develop and teach training modules for C-YES educational activities including Nurse Evaluator Orientation and ongoing C-YES In-Services -Implement enhancements to the C-YES orientation and educational activities based on updates provided by HCS / CANS and C-YES QA data-Analyze CANS recommended scores in relation to Nurse Evaluator determinations-Participates in the development of project goals and objectives, and monitoring achievement of those goals -Collaborate with the Manager QA and Training to develop an effective quality monitoring program. Minimum Requirements
• Current Registered Nurse (RN) license valid in the state of practice is required
• Graduate of an accredited nursing program
• 3-5 years RN experience in medical / surgical / geriatric / LTC / ambulatory care
• 2+ years RN experience
• Ability to review health status questions and make evaluations and determinations based on the UAS-CANS-NY system criteria for enrollment-Ability to work with technology in the workplace including proficiency with Microsoft Office products -Knowledge of the theory, principles, and practices of general professional nursing -Knowledge of state and agency laws and regulations governing general professional nursing practices -Excellent organizational, interpersonal, written, and verbal communication skills -Ability to communicate and work effectively with multi- generational consumers -Ability to demonstrate sensitivity to the concerns of others -Ability to perform comfortably in a fast-paced, deadline-oriented work environment -Ability to successfully execute many complex tasks simultaneously -Strong ability to work independently -Ability to provide effective training in group or 1 : 1 settings
• Valid NYS Driver's license or State ID Preferred Requirements : -Bachelor’s degree in nursing -2+ years previous work experience in Quality and Risk Management in a hospital setting conducting peer reviews -Work experience with the UAS-CANS-NY -Work experience providing QA training.

Home Office Requirements : -Reliable high-speed internet service -Minimum 20 Mpbs download speeds / 50 Mpbs for shared internet connectivity -Minimum 5 Mpbs upload speeds