RN - In-home Assessments

About the role

Field-based Nurse Assessor responsible for performing PCA (Personal Care Assistant) and MDC (Major Diagnostic Category) assessments in patients' homes using established guidelines to authorize appropriate care levels and services.

Key Responsibilities

• Conduct 5+ PCA assessments daily in patient homes, evaluating clinical need against guidelines to ensure medical appropriateness.
• Assess service necessity, coordinate implementation, and advocate for members across care continuum (physician, hospital, family).
• Document comprehensively, refer to MLTSS when appropriate, and testify at Medical Fair Hearings as needed.
• Collaborate with multidisciplinary teams telephonically/in-person to ensure cost-effective, high-quality care delivery.
• Participate in quality improvement and fiscal accountability initiatives.

Qualifications

• Active NJ RN license (or compact state license).
• 2+ years home health nursing experience.
• Valid driver's license and reliable transportation.
• Computer proficiency.