Andrew Rosenthal Email and Phone Number

-Manages day to day operations. -Onboards all new staff and oversees training initiatives.-Engages in daily marketing activities in order to promote and scale business.-Regularly conducts performance improvement initiatives in order to identify efficiencies/inefficiencies and to maintain a high level of: customer service and staff competency.-Created, updated, and maintained Employee Handbook to ensure company core values and company culture is upheld to the highest degree. -Ensures all company short and long term goals are achieved and performance is of highest quality possible.-Manages relations between clients and vendors and ensure customer service is top notch at all times.

-The Enrollment Director ensures that the admission processes are completed within the designated time and all documentation is professionally presented. -Provide training and direction to support Enrollment Specialist RN's in effectively completing assigned responsibilities; UAS, interpreting regulations, policies, operational procedures and objectives; reviewing operations in assigned areas to ensure a high level of quality that is consistent with organizational standards.-Participates in utilization review activities; performs case management analysis; and oversees concurrent review functions with appropriate follow-up action plan/s and intervention/s.-Reviews/investigates difficult or exceptional pre-authorization cases providing feedback to member, provider, and care team. Participates in performing root-cause analyses relative to adverse events or performance improvement strategies as indicated.-Responsible for the day-to-day management and operations of the Enrollment Department. Monitors nursing staff assignments, caseloads, service utilization, and team productivity.-Provides direct supervision to field staff. -Takes report on weekends from Enrollment Specialist RN's.-Ensures all documentation is timely and accurate, including the Uniform assessment, NYIA visits, Plans of Care and encounter visit documentation. -Participates and provides training and continuing education as necessary. -Evaluates and ensures competency requirements are met for all clinical staff. -Identifies appropriate staffing patterns and needs of assigned staff.-Provides Executive Director of Clinical Services with: census, staffing, team productivity, and other reports as requested. -Responsible for performance evaluations and disciplinary action of all assigned staff.-Coordinates appropriate communication and documentation between: members, agency, medical professionals, and referral sources.

· Provide training and direction to support Enrollment Specialist - RN effectively completing assigned responsibilities; UAS, interpreting regulations, policies, operational procedures and objectives; reviewing operations in assigned area to ensure a high level of quality that is consistent with organizational standards.· Participates in utilization review activities; perform case management analysis; and oversees concurrent review functions with appropriate follow-up action plan and intervention.· Reviews/investigates difficult pre-authorization cases providing feedback to member, provider, and care team. Participates in performing root-cause analyses relative to adverse events or performance improvement strategies as indicated.· Responsible for the day-to-day management and operations of the Enrollment Department, monitors nursing staff assignments, caseloads, service utilization, and team productivity.· Provides direct supervision to Field staff.· Ensures all documentation is timely and accurate, including Uniform assessment, reassessments, Plans of Care and encounter visit documentation.· Participates and provide training and continuing education as necessary.· Evaluates and ensures competency requirements are met for all clinical staff.· Identifies appropriate staffing patterns and needs of assigned staff.· Provides Director of Clinical Service with census, staffing, team productivity and other reports as requested.· Responsible for performance evaluations and disciplinary action of all assigned staff.· Coordinates appropriate communication and documentation between members, agency, medical professionals, and referral sources.· Evaluates and suggest revisions to clinical documentation system (UAS-NY) as advised by the UAS-NY reviewer team.· Implements performance improvement plan as directed.· Ensures compliance with State and Federal Home Health regulations.· Ensures compliance with Extended MLTC policies and procedures.

Serve as a support to other team members by making oneself available to answer questions regarding workflows and company policies under direction of clinical manager.

-Conduct monthly telephonic assessments to promote safety and independence within the community, and to encourage self-care of chronic conditions through education of : disease processes, preventative screenings, and treatments.-Manage caseload of 140 members, and provide coordination of benefits with both in network and out of network providers in accordance with Medicaid and Medicare guidelines.-Create and implement patient-centered care plans that address: physical, mental, and spiritual needs thru collaboration with interdisciplinary team.-Review clinical documentation including UAS.-Participate in discharge planning to facilitate transitional care and ensure continuous delivery of appropriate and medically necessary services.

-Manages day to day operations. -Onboards all new staff and oversees training initiatives.-Engages in daily marketing activities in order to promote and scale business.-Regularly conducts performance improvement initiatives in order to identify efficiencies/inefficiencies and to maintain a high level of: customer service and staff competency.-Created, updated, and maintained Employee Handbook to ensure company core values and company culture is upheld to the highest degree. -Ensures all company short and long term goals are achieved and performance is of highest quality possible.-Manages relations between clients and vendors and ensure customer service is top notch at all times.

-Conducts UAS (uniform assessment system) assessment to determine member eligibility into PACE (Program for all inclusive care of the elderly) program.-Complies with all DOH and UAS policies regarding timely submission of documents.-Makes corrections as needed to UAS assessments for consistency with all clinical documentation.

• Conduct enrollment assessments of prospective members and re-assessments of current members in their homes using the Uniform Assessment System (UAS); make enrollment decisions and continued eligibility determination by utilizing clinical expertise and critical thinking skills. As needed, will conduct assessments in settings other than home as needed, e.g. skilled nursing facilities•Complete assessment of service needs at the request of the Care Team, Member's Family/Caregiver to determine service level(s) or need to adjust Service levels•Complete Patient Review Instruments/Screens and all required nursing assessments for active members to determine adjustments/updates in Care Plan and/or to assist with nursing home admission.•Liaison between the member and the Care Management Team; assesses home environment and psychosocial status•Maintain a paperless work environment, which includes compiling assessment package requirements and electronic archiving using Macess Exp Service Module.•Other duties as assigned•Communicates with home care agencies and Care Management Team providing feedback regarding home care issues and the performance of Contract Nurses and Aides.•Provides grass roots, community-based training for frail population care including self-care techniques and prevention strategies.•Ensures that prospective members and significant others/responsible parties understand and are in agreement with enrollment in a managed long-term care plan

-Performs comprehensive assessment of a potential member making appropriate determination for a member’s eligibility into the program-Identifies medical, functional, psychosocial, behavioral health, cultural and linguistic needs of the potential member and discusses person-centered service and care plans for implementation by actively engaging a member/family in decision-making-Effectively completes the required assessment form (UASNY) and other necessary documents within the required timeframes and in accordance with established policies and procedures and State and Federal guidelines and regulations.-Effectively collaborates with the Care Managers to establish continuity of care and interventions as they relate to members’ needs addressing any urgent needs of a member-Recognizes quality of care issues and escalates the issues appropriatelyComplies with all standards for documentation-Maintains member confidentiality and compliance with HIPPA requirements-Participates in regularly scheduled and other staff meetings as requested-Participates in quality improvement initiatives-Train new staff.