Clinical Assessor FT, - RN (Hybrid/Travel) Robeson County, NC

Acentra Health, LLC•Lumberton, NC

2d•Hybrid

About The Position

Acentra Health is seeking a Clinical Assessor to complete needs-based eligibility determinations for patients applying for Medicaid-funded personal care services (PCS) in their homes, adult care homes, or supervised living homes. The role also assesses level of care (LOC) for targeted individuals to support their ability to remain in or return to a home and community-based setting. The position requires a valid driver's license and travel to various locations, including driving up to approximately 120 miles per day and spending up to approximately eight hours driving in a day. Acentra Health reimburses travel expenses, including mileage and parking, and provides technology equipment for the home office and field use, including a laptop. The Clinical Assessor conducts PCS and home- and community-based services (HCBS) assessments using state-approved standardized assessment tools, supports beneficiaries through provider selection and mediation or appeal processes, submits assessments through state-approved interfaces, and responds to state inquiries. The role also participates in case consultations, peer reviews, internal audits, staff meetings, and stakeholder training as assigned. The position requires adherence to corporate policies, including HIPAA privacy and security requirements. The listed annual pay range is USD $77,000 to $80,000. The job posting describes the role as hybrid/travel and full-time.

Requirements

Registered Nurse with a North Carolina or Compact license.
Minimum of two years of nursing experience.
Valid driver's license and ability to travel up to 120 miles roundtrip.
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 execute tasks in a timely manner.
Ability to work independently without a high degree of supervision.

Nice To Haves

Experience with community-based individuals needing assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs).
Experience conducting PCS assessments.
Two or more years of home healthcare experience.
Two or more years of directly related health or medical experience, preferably case management, related to homecare, long-term care, or personal care.
Experience conducting HCBS waiver assessments.
Knowledge of North Carolina Medicaid Clinical Coverage Policy 3L and the PCS Program Provider Manual.
Knowledge of standards of practice related to Medicaid-funded PCS, HCBS programs, and EPSDT.
Knowledge and understanding of public-sector services and supports.
Computer proficiency in Microsoft Excel, Word, and Outlook.
Ability to use person-centered thinking and planning, with awareness of the needs of persons with disabilities.
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 waivers, HCBS programs, EPSDT, medical fragility, and level-of-care determinations.

Responsibilities

Conduct assessments using state-approved standardized tools to determine whether beneficiaries meet PCS eligibility criteria.
Ensure PCS are provided on a needs basis and in quantities appropriate to beneficiaries' unmet needs, considering medical condition and functional, physical, or cognitive impairment.
Maintain the privacy and dignity of individuals receiving PCS assessments.
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.
Provide beneficiaries with guidance and assistance, as necessary, to select PCS providers.
Conduct service plan reviews as needed.
Submit completed assessments using the state-approved interface.
Participate in beneficiary mediation and appeal processes.
Respond to state inquiries regarding assessments conducted.
Attend and actively participate in staff meetings, and conduct case consultations, peer reviews, and internal auditing as assigned.
Conduct initial eligibility assessments for applicants to 1915(c) HCBS programs and, when applicable, annual and change-of-status assessments for current participants.
Read, understand, and adhere to corporate policies, including HIPAA Privacy and Security Rules.
Develop level-of-care recommendations based on clinical evaluations.
Participate in training of PCS stakeholders as needed.
Participate in training of CAP stakeholders as needed.