Clinical Assessor - RN (Hybrid - Travel Required) - PRN

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. We offer unparalleled opportunities to take charge of your career and accelerate better outcomes, making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

About the role

Acentra Health is seeking clinical assessors statewide in North Carolina for an exciting hybrid opportunity. You will work out of your home office and travel to assessment locations within a 60-mile radius of Mecklenburg County, NC (Charlotte). This role involves conducting needs-based eligibility determinations for North Carolinians applying for Medicaid-funded personal care services under the Personal Care Services (PCS) program and the Community Alternatives (CAP) Program.

Under the PCS program, services are provided to NC Medicaid Beneficiaries with medical conditions, cognitive impairments, or disabilities who need hands-on assistance with qualifying activities of daily living (ADLs). Under the CAP Program, home and community-based waivers offer cost-neutral alternatives to institutionalization for individuals at risk of institutionalization if specialized services are unavailable.

Responsibilities

• Conduct assessments to determine PCS eligibility using state-approved standardized tools.
• Ensure PCS are provided based on the beneficiary’s unmet needs, considering the severity of their medical condition, functional disability, or cognitive impairment.
• Maintain the privacy and dignity of individuals receiving assessments at the highest standards.
• Perform new, expedited, annual, change of status, mediation/appeals, reconsideration review, and derivative assessments within established timeframes.
• Include interviews with family members and informal caregivers present during assessments.
• Provide guidance to beneficiaries in selecting PCS providers and conduct service plan reviews as needed.
• Submit completed assessments using state-approved interfaces and participate in mediation and appeal processes.
• Respond to state inquiries regarding assessments and attend staff meetings, case consultations, and internal audits.
• Conduct assessments for initial eligibility and annual/change of status evaluations for 1915(c) HCBS programs using state-approved tools.
• Ensure CAP services are provided based on the beneficiary’s unmet needs and consult with case management entities to generate approvable service plans.
• Verify that service plans completed by assigned case management entities align with the beneficiary’s unmet needs.
• Adhere to corporate policies, including HIPAA Privacy and Security Rules.

Requirements

• Registered Nurse (NC or Compact license).
• Minimum of two years of nursing experience.
• Travel up to a 60-mile radius required.

Qualifications

• Preferred: Experience with community-based individuals needing assistance with ADL and IADL tasks.
• Experience conducting PCS or HCBS waiver assessments.
• 2+ years of home healthcare or directly-related experience in health/medical fields (e.g., case management, homecare, long-term care, or personal care).
• Knowledge of North Carolina Medicaid Clinical Coverage Policies (3L, 3K-1, 3K-2), PCS Program Provider Manual, and relevant federal regulations (42 CFR Part 441 Subpart G, 42 CFR 440.180).
• Understanding of public sector services, Medicaid-funded programs, EPSDT, and level of care determinations.
• Proficiency in Microsoft Excel, Word, Outlook, and web-based software.
• Ability to interact with healthcare professionals, patients, families, and office staff.
• Strong communication skills (spoken, written, and electronic) and attention to detail.
• Ability to work independently, prioritize tasks, and develop level of care recommendations based on clinical evaluations.
• Competency in person-centered thinking, planning, and awareness of the needs of persons with disabilities.
• Participation in training for PCS and CAP stakeholders as needed.

Benefits

Our benefits are designed to provide protection, security, and support for your career and life away from work. They include:

• Comprehensive health plans.
• Paid time off.
• Retirement savings.
• Corporate wellness programs.
• Educational assistance.
• Corporate discounts.

Pay

USD $67,300.00 - USD $93,050.00 per year.