Clinical Assessor RN (Remote + Required Travel)

Acentra Health, LLC•Concord, NC

55d•Hybrid

About The Position

Acentra Health is seeking a Clinical Assessor to conduct statewide North Carolina assessments for the Personal Care Services (PCS) and Community Alternatives (CAP) programs. The position works from a home office and includes travel to assessment locations in the candidate’s region. Candidates should be based in Cabarrus County, including Concord and surrounding cities, to cover field work. The position is described as hybrid, with assessments generally performed in beneficiaries’ primary residences. For PCS, the assessor completes needs-based eligibility determinations for North Carolina Medicaid beneficiaries who need hands-on assistance with qualifying activities of daily living. For CAP, the assessor completes needs-based level-of-care assessments to help eligible individuals remain in or return to home and community-based settings rather than institutional care. Assessments use state-approved standardized tools and interfaces and are conducted in accordance with program requirements, established timeframes, and privacy standards. The assessor may coordinate with beneficiaries, family members, informal caregivers, case management entities, healthcare professionals, and state agencies. The role also includes participation in service plan reviews, mediation and appeals, staff meetings, consultations, peer reviews, auditing, and stakeholder training as needed. The position requires a North Carolina or Compact Registered Nurse license and at least two years of nursing experience, along with travel within a radius of up to 60 miles.

Requirements

Registered Nurse license in North Carolina or a Compact state.
At least two years of nursing experience.
Ability to travel within a radius of up to 60 miles.
Proficiency with Microsoft Excel, Word, and Outlook.
Ability to use computer equipment and web-based software to conduct work.
Ability to interact with office staff, healthcare professionals, patients, families, and other supports.
Effective spoken, written, and electronic communication skills with individuals and groups.
Ability to attend to detail, prioritize effectively, and complete tasks in a timely manner.
Ability to work independently without a high degree of supervision.
Ability to use person-centered thinking and planning and demonstrate awareness of the needs of people with disabilities.
Knowledge of North Carolina Medicaid Clinical Coverage Policy 3L and the PCS Program Provider Manual.
Knowledge of North Carolina Medicaid Clinical Policy 3K-1 and 3K-2, 42 CFR Part 441 Subpart G, and 42 CFR § 440.180.
Knowledge of eligibility criteria for level of care and waiver participation.
Knowledge of standards of practice related to Medicaid-funded Personal Care Services, Medicaid waivers, HCBS programs, EPSDT, medical fragility, and level-of-care determinations.
Knowledge and understanding of public-sector services and supports.

Nice To Haves

Experience with community-based individuals needing personal assistance with ADL and IADL tasks.
Experience conducting PCS assessments.
At least two years of home healthcare experience.
At least two years of directly related health or medical field experience, preferably case management, related to homecare, long-term care, or personal care.
Experience conducting HCBS waiver assessments.

Responsibilities

Conduct PCS assessments using state-approved standardized tools to determine whether beneficiaries meet eligibility conditions and criteria.
Ensure PCS are provided on a needs basis and in quantities appropriate to beneficiaries’ unmet needs and the severity of their medical, functional, physical, or cognitive conditions.
Maintain the privacy and dignity of individuals being assessed for PCS and CAP participation.
Complete new, expedited, annual, change-of-status, mediation/appeals, reconsideration review, and derivative assessments within established timeframes.
Interview family members and informal caregivers who are present during assessments.
Guide and assist beneficiaries, as necessary, in selecting PCS providers.
Conduct service plan reviews as needed.
Submit completed assessments through state-approved interfaces.
Participate in beneficiaries’ mediation and appeal processes and respond to state inquiries regarding assessments conducted.
Attend and actively participate in staff meetings; conduct case consultations, peer reviews, and internal auditing as assigned.
Conduct initial eligibility assessments for applicants to participate in a 1915(c) HCBS program and, when applicable, annual and change-of-status assessments for current participants, using state-approved standardized tools.
Ensure CAP services are provided on a needs basis and in quantities appropriate to beneficiaries’ unmet needs and the severity of their conditions.
Consult with a beneficiary’s selected case management entity, when necessary, to generate an approvable service plan.
Review randomly selected service plans completed by assigned case management entities for appropriateness to the beneficiary’s unmet needs and condition severity.
Read, understand, and follow corporate policies, including HIPAA Privacy and Security Rules.
Develop level-of-care recommendations based on clinical evaluations.
Participate in training PCS and CAP stakeholders as needed.