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

Acentra Health, LLC•Fayetteville, 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) to help targeted individuals remain in or return to home- and community-based settings. Assessors use state-approved standardized assessment tools and submit completed assessments through a state-approved interface. The position requires a valid driver’s license and travel to various locations, including extended driving of up to approximately eight hours in a day and travel of up to 120 miles roundtrip. Mileage and parking expenses are reimbursed. Acentra Health provides the technology needed for a home office, including a laptop for field use. The Clinical Assessor conducts PCS and applicable 1915(c) HCBS assessments, reviews service plans as needed, supports beneficiaries in selecting PCS providers, and participates in mediation and appeal processes. The role also includes responding to state inquiries, case consultations, peer reviews, internal auditing, and stakeholder training as assigned. The assessor must protect beneficiary privacy and dignity, follow applicable corporate policies including HIPAA requirements, and complete work within established timeframes. The posted pay range is USD $77,000–$80,000 per year. The role is described as hybrid and travel-based in Cumberland County, North Carolina.

Requirements

Registered Nurse with an active North Carolina or Compact license.
At least 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 communicate effectively with individuals and groups through spoken, written, and electronic media.
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 interact with healthcare professionals, patients, families, supports, and office staff as needed.
Ability to use person-centered thinking and planning and demonstrate awareness of the needs of people with disabilities.

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.
At least two years of home healthcare experience.
At least two years of directly related experience, preferably case management, in health or medical fields 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 of public-sector services and supports.
Proficiency in Microsoft Excel, Word, and Outlook.
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 requirements.
Ensure PCS are provided on a needs basis and in quantities appropriate to beneficiaries’ unmet needs and medical, functional, physical, or cognitive conditions.
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 present during assessments.
Provide beneficiaries with guidance and assistance, as necessary, to select PCS providers.
Conduct service plan reviews as needed.
Submit completed assessments through the state-approved interface.
Participate in beneficiary mediation and appeal processes.
Respond to state inquiries regarding assessments conducted.
Attend and 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 and CAP stakeholders as needed.