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Acentra Health · 2 days ago

Clinical Assessor (RN - Hybrid)

Durham, NC

Full-time

Hybrid

Entry, Mid Level

$77K/yr - $80K/yr

2+ years exp

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. The Clinical Assessor will conduct assessments for Medicaid beneficiaries to determine eligibility for personal care services, ensuring high standards of privacy and dignity are maintained.

Health Care

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

Qualification

Registered Nurse licenseClinical assessmentsHome healthcare experienceMedicaid policiesADL/IADL tasksComputer proficiencyPerson-centered thinkingCommunication skillsAttention to detailWork independently

Required

Registered Nurse or LCSW license by the applicable state

Minimum of two years of nursing experience

This position requires travel up to a 60 mile radius

Preferred

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