Hamaspik Choice, MLTC is seeking to hire a Nurse Assessor for Dutchess County...Read more
Hamaspik Choice MLTCP is looking for a self-motivated and passionate RN as Utilization...Read more
Hamaspik Choice Inc, is a Managed Long Term Care Plan (MLTCP) serving the Hudson Valley...Read more
We are seeking a Medicare Enrollment Agent to assist individuals in our coverage area...Read more
Hamaspik Choice, MLTC is seeking to hire a Nurse Assessor for Dutchess County. The Nurse Assessor works for the Managed Long Term Care Plan conducting UAS-NY assessments and reassessments to evaluate potential members for enrollment eligibility in the MLTC Plan. Clinical assessment skills are critical. Position entails collaboration with the Utilization Management team, members and family members in providing the best possible individualized care.
- Conducts UAS-NY reassessment visits
- Post visit communication with members of care management and care planning teams.
- Initiates development and coordination of a safe plan of care with member/family to meet all members’ needs; coordinates with rest of care management team.
- Documentation of UAS-NY and visit notes including progress note and plan of care
- Participates in the agency QA Program, as requested.
- Performs assessments and completes documentation within the time frames set forth by the Agency
- Participates in mandatory staff meetings
Specific knowledge, skills, and Abilities:
- Strong organizational & communication skills
- Computer proficiency
- Ability to work autonomously and as part of a team
Hamaspik Choice MLTCP is looking for a self-motivated and passionate RN as Utilization Review Nurse for a Full-Time position. UAS experience preferred.
Candidate will be responsible for the assessment of member needs and identification of solutions that promote high quality and cost effective health care services.
- Responsible for the development of a person centered service plan/ plan of care based off of the assessment documentation completed by the visiting RN.
- Managing requests for medical services and renders clinical determinations.
- Deliver timely notification detailing clinical decisions and provide intervention to decrease delays and denials.
- Work within a multidisciplinary team to help identify and manage members who are in need of additional care or support in their home to improve their quality of life.
- Assess and process all authorization requests to determine medical necessity to ensure all care services, member education, and preventative interventions are maintained.
- Ability to make decisions that are financially prudent, highly ethical, in compliance with all governing regulations, and demonstrate a commitment to our members welfare and well-being.
Hamaspik Choice Inc, is a Managed Long Term Care Plan (MLTCP) serving the Hudson Valley Region. Hamaspik Choice is seeking a qualified individual to join our Compliance Department, as Compliance Analyst.
The Compliance Analyst will assist with implementing the Compliance Program, and will conduct Compliance Monitoring activities including auditing and investigating the plan’s operations to ensure compliance with all requirements. The Compliance Analyst will be responsible for overseeing continuous projects to assure operational compliance with regulations.
The position will include:
- Auditing and Monitoring of the plan's operations
- Research of regulations in collaboration with legal counsel
- Implementing updated policies and procedures
- Conducting staff trainings
- Develop internal protocol to assure compliance on multiple aspects of the plan’s operations
Candidate will have:
- Regulatory experience in the Medicaid Managed Care industry
- Experience with auditing and investigating company processes
- Experience with writing, developing and implementing managed care policies and procedures
- Knowledge of MLTC requirements
We are seeking a Medicare Enrollment Agent to assist individuals in our coverage area through the important decision-making process of selecting our Medicare plan. Applicant must be available to work in New York State.
Responsible for growing Medicare Advantage enrollment volume by targeting Medicare beneficiaries that have dual eligible status (Medicaid and Medicare) while adhering to all mandates set for the in the CMS marketing and compliance guidelines as well as Hamaspik Choice's policies and procedures.
- Identify prospective enrollees and determine eligibility for participation in the D-SNP Medicare product
- Guide consumers through the health insurance policy selection and application process and serve as subject matter expert for health insurance enrollments
- Quickly grasp new concepts and product offerings
- Learn and adapt quickly, while following Hamaspik Choice internal policies and procedures
- Comply with Federal CMS and State legal requirements and standards
- Be the face individuals can trust at the consumer level, and serve as a brand ambassador for the organization in the communities of the Hamaspik Choice service area
- Keep informed and adhere to current information pertaining to marketing activity guidelines set forth by various regulatory agencies—this includes providing enrollees with all corresponding materials and documentation
- Conduct and participate in outreach efforts as required
- Attend and participate in sales meetings, training programs, conventions, and special events to promote product education and awareness for the dual eligible population
- Drive continuous improvement throughout the sales process, raising opportunities for higher commissions
- Promote retention and minimize rapid disenrollment by providing accurate, consistent and timely service and follow-up
Specific Knowledge, Skills, and Abilities:
- Excellent customer service and communication skills
- Good organizational, writing, communication, and interpersonal skills.
- Negotiation and closing skills
- Ability to deal with problems involving several variables in standardized situations.
- Ability to solve practical problems and deal with a variety of situations where only limited standardization exists.
• Develop and implement an annual Quality Management work plan, and lead Quality Assurance initiatives including the monitoring and evaluation of the quality of all programs.
• Implement and coordinate the quality committee structure, as required by regulation.
• Lead HEDIS/QARR submissions, and lead quality improvement projects, designed to improve outcomes for enrolled members.
• Implement initiatives to conduct member satisfaction surveys.
• Develop and implement processes to monitor the quality of network providers.
• Responsible for all incident management including the investigations and corrective action plans of all incidents within the company and its providers.
• Oversee all quality related reporting requirements.
Education- BA required in healthcare, MA preferred.
Experience- 5 years' experience within a managed care plan, with experience leading Quality Assurance activities in Medicaid and Medicare health plans preferred.
Responsibilities include building and maintaining a successful working relationship between network providers to ensure a geographically broad access and stable network. Candidate will also negotiate cost effective fees, confirm service capability, respond to provider inquiries, and educate providers on contract expectations, processes and paperwork. Individual must be a quick learner, able to multi-task, and have excellent communication and organization skills.
The Compliance Analyst will assist with implementing the Compliance Program, and will conduct Compliance Monitoring activities including auditing and investigating the plan's operations to ensure compliance with all requirements. The Compliance Analyst will be responsible for overseeing continuous projects to assure operational compliance with regulations.
The position will include:
• Auditing and Monitoring of the plan's operations
• Research of regulations in collaboration with legal counsel
• Implementing updated policies and procedures
• Conducting staff trainings
• Develop internal protocol to assure compliance on multiple aspects of the plan's operations
Candidate will have:
• Regulatory experience in the Medicaid Managed Care industry
• Experience with auditing and investigating company processes
• Experience with writing, developing and implementing managed care policies and procedures
• Knowledge of MLTC requirements
The Home Care Specialist is responsible for the coordination of home care benefits which include PCA, CDPAS, HHA and skilled services to secure coverage.
Responsibility includes coordination for new members, existing members as well as ongoing communication with all home care providers.
Candidate must be able to multi-task and have excellent communication and organization skills.