Clinical Assessor - RN (Hybrid in NC \ Travel Required)

Responsibilities

Conducts assessment to determine whether the beneficiary meets the conditions and criteria for PCS eligibility, using state-approved standardized assessment tool(s). Ensures that PCS are provided on a "needs basis" in quantities appropriate to the Beneficiary's unmet need for services based on the severity of their medical condition, functional disability, physical, or cognitive impairment. Ensures that the privacy and dignity of individuals receiving assessment for PCS is maintained at the highest standards. Ensures that new, expedited, annual, change of status, mediation/appeals, reconsideration review, and derivative assessments are conducted within established timeframes. Include an interview with family members and informal caregivers who are present at the time of the assessment. Provide the Beneficiary with guidance and assistance, as necessary, to select PCS providers. Conduct service plan reviews as needed. Submit the completed assessments using state-approved interface Participate in the Beneficiary’s mediation and appeal processes. Respond to state inquiries regarding assessments conducted. Attend and actively participate in staff meetings and conduct case consultations/peer reviews/internal auditing as assigned. Provide assessments for initial eligibility determinations for an applicant to participate in a 1915(c) HCBS program, and, when applicable, annual and change of status assessments for participant currently participating in a 1915(c) HCBS program, using state-approved standardized assessment tool(s). Ensures that CAP services are provided on a "needs basis" in quantities appropriate to the Beneficiary's unmet need for services based on the severity of their medical condition, functional disability, physical, or cognitive impairment. Ensures that the privacy and dignity of individuals receiving assessment for CAP participation is maintained at the highest standards. Consult, when necessary, with the Beneficiary’s selected case management entity to generate an approvable service plan. Ensure that the randomly selected Service Plan completed by the Beneficiary’s assigned case management entity is appropriate to the Beneficiary’s unmet need for services, based on the severity of their medical condition, functional disability, physical, or cognitive impairment. Include an interview with family members and informal caregivers who are present at the time of the assessment. Submit the completed assessments using state-approved interface Participate in the Beneficiary’s mediation and appeal processes. Respond to state inquiries regarding assessments conducted. Attend and actively participate in staff meetings and conduct case consultations/peer reviews/internal auditing as assigned. Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules. The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.

Qualifications

Required Qualifications Registered Nurse (NC or Compact license) Minimum of two years of nursing experience. This position requires travel up to a 60 mile radius.

Preferred Qualifications

Experience with community-based individuals needing personal assistance with ADL and IADL tasks is highly preferred. Experience conducting PCS assessments highly preferred. 2+ years of home healthcare experience preferred. 2+ years of directly-related experience (preferably case management) in the health or medical field, directly related to homecare, long-term care, or personal care is preferred. Experience conducting HCBS waiver assessments highly preferred. Knowledge of North Carolina Medicaid Clinical Coverage Policy (Clinical Policy) 3L and PCS Program Provider Manual Knowledge of standards of practice related to Medicaid-funded Personal Care Services, home and community-based services (HCBS) programs, and EPSDT. Knowledge and understanding of public sector services and supports. Computer proficiency in Microsoft Excel, Word and Outlook. Ability to utilize computer equipment and web-based software to conduct work. Ability to interact with various office staff as needed to support necessary workflows. Ability to interact with healthcare professionals, patients, their families and other supports. Ability to communicate effectively to individuals and groups through spoken, written and electronic media. Ability to attend to detail, effectively prioritize and execute tasks in a timely manner. Ability to work independently without a high degree of supervision. Develops level of care recommendations based upon clinical evaluations. Participates in training of PCS stakeholders as needed. Ability to use person-centered thinking, planning, and have competency in awareness of the needs of persons with disabilities. Knowledge of North Carolina Medicaid Clinical Policy 3K-1 and 3K-2, and 42 CFR Part 441 Subpart G, 42 CFR § 440.180. Knowledge of eligibility criteria for LOC and Waiver Participation. Knowledge of standards of practice related to Medicaid waivers, home and community-based services (HCBS) programs, EPSDT, medical fragility, and level of care determinations. Participates in training of CAP stakeholders as needed. Why us? We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes. We do this through our people. You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more. Thank You! We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search! ~ The Acentra Health Talent Acquisition Team

Pay Range

Usd $67,300.00 - Usd $93,050.00 /Yr.