R&E Nurse- Med Care Services (709220)

Critical Incident Management Unit – Review and Evaluation Nurse

This position is in the Division of Participant Supports, Bureau of Coordinated and Integrated Services within the Office of Long-Term Living (OLTL). The incumbent is assigned a team tasked (1) to provide effective assistance to participants, families, and local agencies in addressing participants’ concerns, grievances, service needs or preferences, specifically as they concern home and community-based programs; and (2) to ensure that quality, effective and efficient services are provided to participants in their communities.

The functional areas within this division addresses these areas through service plan review as well as incident and case management. As a member of a team, the incumbent will primarily be responsible for the review of reportable incidents and service plans of participants receiving home and community-based services through the Act 150 program, Community Health Choices (CHC), and OBRA waivers. The incumbent will also 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 in this position works to ensure that participants receiving services through OLTL home and community-based programs receive services that are appropriate to the individual, compatible with the provisions of the program, consistent across the state, and efficient regarding the use of available resources. In addition, the incumbent ensures services are provided to participants to enhance the quality of their lives, support them to live as independently as they choose, and enhance health and welfare. Clinical expertise of physical disabilities, medical conditions, and treatment modalities is required.

Description of Duties:

Assess and review reportable incidents and service plans for participants receiving home and community-based services through various waiver programs. Ensure individuals are eligible, 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 waiver requirements, providing technical assistance and seeking clarification on reportable incidents. Review and evaluate medical documentation to determine whether home and community-based services 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 eligibility and individual cases as necessary. 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.

Assist in evaluation and monitoring of the existing Home and Community Based Services (HCBS) waivers and the development of new HCBS initiatives. This responsibility requires a thorough knowledge of home and community-based services as alternatives to institutional placement. Assist other team members in the unit in the day to day operations of all OLTL home and community-based waivers.

Review policies, procedures, and standards in HCBS programs to ensure that the HCBS 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 home and community-based program 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. Serve as a member of the Mortality Review Team. Performs other related duties as necessary.

Decision Making:

Working with 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:

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.

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