Quality Assurance Nurse Specialist (Hybrid/Remote) - 26020

Description & Requirements

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

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.

The Quality Assurance Nurse Specialist position is a Hybrid/Remote position for NY State residents only. This position will travel for mandatory trainings/meetings and in-person Fair Hearings as needed.

At Maximus, we are committed to cultivating a positive and inclusive work environment, and we are pleased to offer the following:

Work/Life Balance Support - Flexibility tailored to your needs!

Competitive Compensation - Bonuses based on performance included!

️ Comprehensive Insurance Coverage - Choose from various plans, including Medical, Dental, Vision, Prescription, and partially funded HSA. Additionally, enjoy Life insurance benefits and discounts on Auto, Home, Renter's, and Pet insurance.

Future Planning - Prepare for retirement with our 401K Retirement Savings plan and Company Matching.

️ Paid Time Off Package - Enjoy PTO, Holidays, and extended sick leave, along with Short and Long Term Disability coverage.

Holistic Wellness Support - Access resources for physical, emotional, and financial wellness through our Employee Assistance Program (EAP).

Recognition Platform - Acknowledge and appreciate outstanding employee contributions.

Diversity, Equity, and Inclusion Initiatives - Join a workplace committed to fostering diversity and inclusion.

Tuition Reimbursement - Invest in your ongoing education and development.

Employee Perks and Discounts - Additional benefits and discounts exclusively for employees.

Maximus Wellness Program and Resources - Access a range of wellness programs and resources tailored to your needs.

Professional Development Opportunities: Participate in training programs, workshops, and conferences.

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:

-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

#NYMC #LI-Hybrid

EEO Statement

Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We're proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you. A committed and diverse workforce is our most important resource. Maximus is an Affirmative Action/Equal Opportunity Employer. Maximus provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual
orientation, gender identity, national origin, protected veteran status or disabled status.

Pay Transparency

Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. Annual salary is just one component of Maximus's total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards. Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off. Compensation ranges may differ based on contract value but will be commensurate with job duties and relevant work experience. An applicant's salary history will not be used in determining compensation. Maximus will comply with regulatory minimum wage rates and exempt salary thresholds in all
instances.