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

Acentra Health, LLC•Winston-Salem, NC

16h•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. PCS supports beneficiaries with medical conditions, cognitive impairments, or disabilities who need hands-on assistance with qualifying activities of daily living. CAP provides home- and community-based waiver services as alternatives to institutional care for eligible beneficiaries at risk of institutionalization. The position is hybrid, with work performed from a home office and travel to assessment locations in the assigned region. Assessments generally take place in the beneficiary’s primary residence. Candidates should be based in Forsyth County, including Winston-Salem and surrounding cities, and must travel within a radius of up to 60 miles. The assessor uses state-approved standardized tools and interfaces, works with beneficiaries, families, informal caregivers, case management entities, and state agencies, and supports related service planning, reviews, and appeals. The role requires an active Registered Nurse license in North Carolina or a compact state and at least two years of nursing experience. The listed annual pay range is USD $67,300 to USD $93,050. Acentra Health describes benefits including comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Requirements

Registered Nurse license in North Carolina or a compact state.
At least two years of nursing experience.
Ability to travel up to a 60-mile radius.
Computer proficiency with Microsoft Excel, Word, and Outlook.
Ability to use computer equipment and web-based software.
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 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 practice standards 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 practice standards 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 needing 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 assessment tools to determine eligibility.
Determine PCS service quantities based on beneficiaries’ unmet needs and the severity of their medical conditions, functional disabilities, or physical or cognitive impairments.
Maintain the privacy and dignity of individuals being assessed for PCS and CAP services.
Complete new, expedited, annual, change-of-status, mediation/appeals, reconsideration review, and derivative PCS assessments within established timeframes.
Interview family members and informal caregivers who are present during assessments.
Guide and assist beneficiaries, as needed, in selecting PCS providers.
Conduct service plan reviews as needed.
Submit completed assessments through the state-approved interface.
Participate in beneficiaries’ mediation and appeal processes and respond to state inquiries about assessments.
Attend and participate in staff meetings; conduct assigned case consultations, peer reviews, and internal audits.
Conduct initial eligibility assessments for applicants to 1915(c) HCBS programs and, when applicable, annual and change-of-status assessments for current participants.
Determine CAP service quantities based on beneficiaries’ unmet needs and the severity of their medical conditions, functional disabilities, or physical or cognitive impairments.
Consult with a beneficiary’s selected case management entity, when necessary, to develop an approvable service plan.
Review randomly selected service plans prepared by assigned case management entities for appropriateness to beneficiaries’ unmet needs.
Read, understand, and comply with 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.