RN Clinical Assessor

Acentra Health, LLC•Buckhannon, OH

7d•Hybrid

About The Position

Acentra Health is seeking a Registered Nurse Clinical Assessor to educate and conduct medical eligibility assessments of West Virginia Medicaid recipients seeking community-based services. The role follows prescribed guidelines to administer Pre-Admission Screenings for medical eligibility for the Personal Care Program and the Aged & Disabled Waiver Program. The assessor manages an assigned caseload, ensuring assessments are scheduled, appropriate people are present, assessments are completed, and information is entered into Atrezzo within required timelines. This hybrid position is based in West Virginia and combines remote work from home with field assessments and quarterly in-office meetings. It requires extensive local travel within an assigned catchment area and occasional travel outside that area. Applicants should ideally reside in Lewis, Barbour, Upshur, Randolph, Pocahontas, or Pendleton County for optimal field coverage.

Requirements

Valid, unrestricted Registered Nurse license for West Virginia or a compact license.
Associate of Science in Nursing degree from an accredited college or university.
Valid West Virginia driver's license and access to reliable transportation.
Willingness to travel to homes and facilities within the catchment area, with occasional travel outside the area to provide coverage or attend meetings and events.
Organizational skills, excellent customer service, good interpersonal communication, and flexibility.
Ability to accurately assess medical conditions, symptoms, and functional abilities.
Computer skills, including Microsoft Outlook, Microsoft Word, Microsoft Edge, and Google Chrome.

Nice To Haves

Bachelor of Science in Nursing degree.
Two years of experience in a home care setting.
Two years of experience with the aging population or people with disabilities, preferably in the West Virginia Personal Care program.
Knowledge of Personal Care and Aged and Disabled Waiver program policies and procedures.

Responsibilities

Document contacts, schedule appointments, travel to conduct Pre-Admission Screening assessments, and document them within prescribed timelines.
Participate in inter-rater reliability activities to support consistent assessments and adherence to protocols.
Participate in denial hearings as necessary.
Contact physicians and facilities to confirm medical information.
Conduct assessments using state-approved standardized tools to determine whether beneficiaries meet PCS eligibility criteria.
Ensure Personal Care Services are provided on a needs basis and in amounts appropriate to beneficiaries' unmet needs and medical, functional, physical, or cognitive conditions.
Maintain the privacy and dignity of individuals receiving 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, in selecting PCS providers.
Submit completed assessments using the state-approved interface.
Participate in beneficiary mediation and appeal processes.
Attend and actively participate in staff meetings, and conduct case consultations, peer reviews, and internal auditing as assigned.
Read, understand, and follow corporate policies, including HIPAA Privacy and Security Rules.
Perform other education- and experience-related duties that management may assign.