Clinical Assessor, - RN (Hybrid/Travel) Rocky Mount, NC

Acentra Health, LLC•Rocky Mount, NC

12h•Hybrid

About The Position

Acentra Health is seeking a Clinical Assessor to conduct needs-based eligibility and level-of-care assessments for North Carolina Medicaid beneficiaries applying for Personal Care Services (PCS) and Community Alternatives Program (CAP) services. The programs support eligible beneficiaries with medical conditions, cognitive impairments, or disabilities by helping them access assistance and home- and community-based services that enable them to remain in or return to community settings. The position is hybrid: the assessor works from a home office and travels to assessment locations, generally beneficiaries’ primary residences. Candidates should be based in Edgecombe or Nash County, including Rocky Mount and surrounding cities, and must be able to travel within a 60-mile radius. Assessments use state-approved standardized tools and interfaces and include eligibility determinations, service plan reviews, coordination with case management entities, and participation in mediation and appeal processes. The assessor also responds to state inquiries and participates in staff meetings, case consultations, peer reviews, internal auditing, and stakeholder training as needed.

Requirements

Current Registered Nurse license in North Carolina or a compact-state license.
At least two years of nursing experience.
Ability to travel within a 60-mile radius.
Computer 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.
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 develop level-of-care recommendations based on clinical evaluations.
Ability to use person-centered thinking and planning and demonstrate awareness of the needs of people 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.
Knowledge of North Carolina Medicaid Clinical Coverage Policy 3L and the PCS Program Provider Manual.
Knowledge of standards of practice related to Medicaid-funded Personal Care Services, HCBS programs, and EPSDT.
Knowledge and understanding of public-sector services and supports.

Nice To Haves

Experience with community-based individuals who need 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 experience, preferably case management, in health or medicine 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 criteria.
Ensure PCS are provided on a needs basis and in quantities appropriate to beneficiaries’ unmet needs and the severity of their medical conditions, disabilities, or impairments.
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.
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 beneficiary mediation and appeal processes and respond to state inquiries about completed assessments.
Attend and actively participate in staff meetings and conduct assigned case consultations, peer reviews, and internal auditing.
Conduct initial eligibility assessments for applicants to 1915(c) HCBS programs and, when applicable, annual and change-of-status assessments for 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 medical conditions, disabilities, or impairments.
Maintain the privacy and dignity of individuals receiving CAP participation assessments.
Consult with a beneficiary’s selected case management entity, when necessary, to develop an approvable service plan.
Ensure randomly selected service plans prepared by assigned case management entities are appropriate to beneficiaries’ unmet needs.
Adhere to corporate policies, including HIPAA Privacy and Security Rules.
Participate in training of PCS and CAP stakeholders as needed.
Perform other education- and experience-related duties that management may assign.