Alamance)

Vaya Health•Wentworth, NC

3h•$68,033 - $88,443•Remote

About The Position

The Personal Care Services (PCS) Assessor Registered Nurse is responsible for completing needs-based assessments/eligibility determinations for Medicaid-beneficiaries in Vaya's region who are applying for State Plan Personal Care Services provided in their home or in adult care or supervised living homes. These Medicaid-beneficiaries have a medical condition, cognitive impairment, or disability and demonstrate unmet needs for hands-on assistance with qualifying activities of daily living (ADLs). The PCS Assessor Registered Nurse is responsible for scheduling appointments, administering telephonic and face-to-face assessments in beneficiaries’ home and community, working with healthcare professionals, and submitting service authorization requests (SARs) on behalf of PCS providers.

Requirements

Knowledge of North Carolina Medicaid Clinical Coverage Policy (Clinical Policy) 3L and PCS Program Provider Manual
Knowledge of standards of practice related to Medicaid-funded State Plan Personal Care Services, home and community-based services (HCBS) programs, and Early and Periodic Screening, Diagnostic and Treatment (EPSDT).
Knowledge and understanding of public sector services and supports.
Computer proficiency in Microsoft Excel, Word and Outlook.
Ability to utilize computer equipment and web-based software to conduct work.
Ability to interact with various office staff as needed to support necessary workflows.
Ability to interact with healthcare professionals, patients, their families and other supports.
Ability to communicate effectively to individuals and groups through spoken, written and electronic media.
Ability to attend to detail, effectively prioritize and execute tasks in a timely manner.
Ability to work independently without a high degree of supervision.
Develops level of care recommendations based upon clinical evaluations.
Participates in training of PCS stakeholders as needed.
Ability to use person-centered thinking, planning, and have competency in awareness of the needs of persons with disabilities.
Must have active licensure in North Carolina as a Registered Nurse (RN).
Must reside in North Carolina or within 40 miles of the North Carolina border.

Nice To Haves

Experience with community-based individuals needing personal assistance with ADL and IADL tasks is highly preferred.
Experience conducting PCS assessments highly preferred.

Responsibilities

Works with members, family members, and/or other healthcare professionals to schedule assessments.
Conducts assessment to determine whether the member meets the conditions and criteria for PCS eligibility, using standardized assessment tool(s).
Conducts interviews with family members and informal caregivers who are present at the time of the assessment.
Ensures that assessments are conducted within established timeframes.
Performs expedited assessments over the phone as needed.
Provides education and assistance to the member, as necessary, to select PCS providers.
Works with prescribers and/or other healthcare professionals to ensure that requests are accurate and complete.
Submits service authorization requests (SARs) on behalf of PCS provider.
Ensures that the privacy and dignity of individuals receiving assessment for PCS is maintained at the highest standards.
Participates in mediation and appeal processes, as needed.
Responds to state inquiries regarding assessments conducted.
Attend and actively participate in staff meetings and conduct case consultations/peer reviews/internal auditing as assigned.