Clinical Assessor (RN - Hybrid)

About the role

Acentra Health is seeking clinical assessors statewide in North Carolina for an exciting opportunity. The role involves working out of a home office and traveling to assessment locations in your region. You will work under the Personal Care Services (PCS) and Community Alternatives (CAP) programs, providing services to NC Medicaid beneficiaries who require hands-on assistance with ADLs and IADLs.

Responsibilities

• Conducts assessment to determine PCS eligibility using state-approved standardized assessment tools.
• Ensures PCS services are provided on a "needs basis" based on the beneficiary's medical condition, functional disability, or cognitive impairment.
• Maintains the privacy and dignity of beneficiaries during assessments.
• Interviews family members and informal caregivers during assessments.
• Selects PCS providers for beneficiaries and provides guidance and assistance as needed.
• Reviews service plans and participates in beneficiary's mediation and appeal processes.
• Responds to state inquiries regarding assessments conducted.
• Attends and participates in staff meetings and conducts case consultations/peer reviews/internal auditing as assigned.
• Conducts initial and annual assessments for 1915(c) HCBS programs.
• Ensures CAP services are provided on a "needs basis" based on the beneficiary's medical condition, functional disability, or cognitive impairment.
• Interviews family members and informal caregivers during assessments.
• Submits completed assessments using state-approved interfaces.
• Provides 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 participants currently participating in a 1915(c) HCBS program.
• Adheres to corporate policies including HIPAA and its Privacy and Security Rules.

Qualifications

• Registered Nurse or LCSW license by the applicable state.
• Minimum of two years of nursing experience.
• Experience with community-based individuals needing personal assistance with ADL and IADL tasks is highly preferred.
• Experience conducting PCS assessments is highly preferred.
• Two+ years of home healthcare experience preferred.
• Two+ 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 is highly preferred.
• Knowledge of North Carolina Medicaid Clinical Coverage Policy (Clinical Policy) 3L and PCS Program Provider Manual.
• 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.
• Knowledge of North Carolina Medicaid Clinical Policy 3K-1 and 3K-2, and 42 CFR Part 441 Subpart G, 42 CFR440.180.
• 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

Our benefits are a key component of your rewards package. They include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Pay

The pay for this position is listed below. USD $77,000.00 - USD $80,000.00 /Yr.