Clinical Assessor (RN - Hybrid - PRN)

Acentra Health • Durham, NC

77d • $37 • Hybrid

About The Position

Acentra Health is looking for a Clinical Assessor to join our growing team. 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. Under the Community Alternatives (CAP) Program, home and community-based waivers provide cost-neutral alternatives to institutionalization for Beneficiaries, in specified target populations, who would be at risk for institutionalization if specialized Waiver services are not available. Services are intended for situations where no household member, relative, caregiver, landlord, community agency, volunteer agency, or third-party payer is able or willing to meet the assessed and required medical, psychosocial, and functional needs of the approved CAP Beneficiary. The CAP Assessor is responsible for the completion of needs-based eligibility determinations for North Carolinians who are applying for these Medicaid-funded personal care services provided in their home or in adult care or supervised living homes. The CAP Assessor is responsible for completion of needs-based assessments of level of care (LOC) to allow targeted individuals to remain in or return to a home and community-based setting. Assessments are generally performed in the beneficiary's primary residence. Daily tasks include processing CAP SRFs (services referral forms). If there are inquiries related to SRF processing, initiate RAIs (Requests for Additional Information) exclusively for SRFs that have been pending for three days or less. In cases where an SRF is missing the required information, issue a Technical Denial (TD) and document the reasons in the communication log. Monitor the CAP SRF queue each day to comply with the contract's stipulation of a maximum of 14 business days in the queue. Prior to processing SRFs, check for potential duplicate beneficiaries. Additionally, complete CAP SRF 2nd level when necessary. Position is hybrid. Candidates should be based within Durham County of North Carolina to be able to cover the field work involved. This position is PRN.

Requirements

• 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.

Nice To Haves

• 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.
• Minimum of two years' experience in a home care setting preferred.
• Knowledge of standards of practice related to Medicaid waivers, home and community-based services (HCBS) programs, EPSDT, medical fragility, and level of care determinations.
• Knowledge and understanding of public sector services and supports.
• Understanding of services provided under the CAP waivers.
• 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 CAP stakeholders as needed.
• Ability to use person-centered thinking, planning, and have competency in awareness of the needs of persons with disabilities.

Responsibilities

• 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).
• Complete CAP MDT RN reviews on all finalized CAP assessments.
• Ensure 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.
• Ensure 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.
• 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.

Benefits

• Retirement savings
• Corporate wellness
• Educational assistance
• Corporate discounts

What This Job Offers

• Industry: Ambulatory Health Care Services
• Number of Employees: 1,001-5,000 employees