Clinical Assessor-RN (Hybrid-Travel) Durham, NC (PRN)

Acentra Health, LLC•Morrisville, VT

2d•Hybrid

About The Position

Acentra Health is looking for a Clinical Assessor to join their growing team. This position is hybrid and PRN, requiring candidates to be based within Durham County of North Carolina to cover field work. The role involves working from a home office and traveling to assessment locations within a designated region. The Clinical Assessor is responsible for completing needs-based eligibility determinations for North Carolinians applying for Medicaid-funded personal care services in their home or in adult care or supervised living homes, under the Community Alternatives (CAP) Program. These services provide cost-neutral alternatives to institutionalization for beneficiaries at risk of institutionalization. The CAP Assessor completes needs-based assessments of the level of care (LOC) to enable targeted individuals to remain in or return to a home and community-based setting, generally performed in the beneficiary’s primary residence. Daily tasks include processing CAP SRFs (services referral forms), initiating Requests for Additional Information (RAIs) for pending SRFs, issuing Technical Denials (TD) for missing information, monitoring the CAP SRF queue to meet contract stipulations, checking for duplicate beneficiaries, and completing CAP SRF 2nd level when necessary. The primary role involves completing CAPDA and CAPC comprehensive assessments, with potential cross-training in up to four additional areas.

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.
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.
Ability to use person-centered thinking, planning, and have competency in awareness of the needs of persons with disabilities.

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.
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.
Participates in training of CAP stakeholders as needed.

Responsibilities

Completing CAPDA and CAPC comprehensive assessments.
Processing CAP SRFs (services referral forms).
Initiating RAIs (Requests for Additional Information) for SRFs pending for three days or less.
Issuing a Technical Denial (TD) and documenting reasons in the communication log if an SRF is missing required information.
Monitoring the CAP SRF queue daily to comply with the contract's stipulation of a maximum of 14 business days in the queue.
Checking for potential duplicate beneficiaries prior to processing SRFs.
Completing CAP SRF 2nd level when necessary.
Receiving cross-training in up to four additional areas.