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

Job Summary and Responsibilities

Acentra Health is seeking clinical assessors statewide in North Carolina for an exciting opportunity. You work out of your home office and travel to assessment locations in your region.

• Determines whether beneficiaries meet the conditions and criteria for PCS eligibility using state-approved standardized assessment tools.
• Ensures PCS services are provided on a "needs basis" in appropriate quantities based on beneficiaries' medical conditions, functional disabilities, or impairments.
• Maintains the privacy and dignity of beneficiaries during assessments.
• Conducts expedited, annual, change of status, mediation/appeals, reconsideration review, and derivative assessments within established timeframes.
• Interviews family members and informal caregivers present during assessments.
• Provides beneficiaries with guidance and assistance in selecting PCS providers.
• Conducts service plan reviews as needed.
• Sends completed assessments using state-approved interfaces.
• Participates in Beneficiary's mediation and appeal processes.
• Responds to state inquiries regarding assessments conducted.
• Attends and actively participates in staff meetings and conducts case consultations/peer reviews/internal audits as assigned.
• Conducts comprehensive clinical assessments to determine CAPDA or CAPC eligibility using state-approved standardized assessment tools.
• Reads, understands, and adheres to all corporate policies, including HIPAA and its Privacy and Security Rules.

Qualifications

• Registered Nurse (NC or Compact license)
• Minimum of two years of nursing experience
• Experience with community-based individuals needing personal assistance with ADL and IADL tasks (preferred)
• Experience conducting CAPC and CAPDA assessments (preferred)
• Two to three years of home healthcare experience preferred
• Two to three years of directly-related experience (preferably case management) in the health or medical field, directly related to homecare, long-term care, or personal care (preferred)
• Experience conducting HCBS waiver assessments (preferred)
• Knowledge of North Carolina Medicaid Clinical Policy 3K-1 and 3K-2, and 42 CFR Part 441 Subpart G, 42 CFR440.180 (required)
• Knowledge of North Carolina Medicaid Clinical Coverage Policy (Clinical Policy) 3L and PCS Program Provider Manual (required)
• Knowledge and understanding of public sector services and supports (required)
• Computer proficiency in Microsoft Excel, Word, and Outlook (required)
• Ability to utilize computer equipment and web-based software to conduct work (required)
• Ability to interact with various office staff as needed to support necessary workflows (required)
• Ability to interact with healthcare professionals, patients, their families, and other supports (required)
• Ability to communicate effectively to individuals and groups through spoken, written, and electronic media (required)
• Ability to attend to detail, effectively prioritize, and execute tasks in a timely manner (required)
• Ability to work independently without a high degree of supervision (required)
• Develops level of care recommendations based upon clinical evaluations (required)
• Participates in training of PCS stakeholders as needed (preferred)
• Knowledge of eligibility criteria for LOC and Waiver Participation (required)
• Knowledge of standards of practice related to Medicaid waivers, home and community-based services (HCBS) programs, EPSDT, medical fragility, and level of care determinations (required)
• Participates in training of CAP stakeholders as needed (preferred)

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

• Comprehensive health plans
• Paid time off
• Roth 401(k) retirement savings
• Corporate wellness
• Employee assistance program
• Education assistance
• Corporate discounts