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

Company Overview Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Job Summary Acentra Health is looking for a Clinical Assessor to join our growing team. This hybrid position requires candidates to be based within Wake County, North Carolina, to cover the field work involved. Responsibilities Conduct assessments to determine whether the beneficiary meets the conditions and criteria for PCS eligibility, using state-approved standardized assessment tool(s). Ensure PCS are provided on a "needs basis" in quantities appropriate to the Beneficiary's unmet need for services based on the severity of their medical condition, functional disability, physical, or cognitive impairment. Ensure the privacy and dignity of individuals receiving assessment for PCS is maintained at the highest standards. Ensure that new, expedited, annual, change of status, mediation/appeals, reconsideration review, and derivative assessments are conducted within established timeframes. Include an interview with family members and informal caregivers who are present at the time of the assessment. Provide the Beneficiary with guidance and assistance, as necessary, to select PCS providers. Conduct service plan reviews as needed. Submit the completed assessments using state-approved interface. Participate in the Beneficiary's mediation and appeal processes. Respond to state inquiries regarding assessments conducted. Attend and actively participate in staff meetings and conduct case consultations/peer reviews/internal auditing as assigned. Provide assessments for initial eligibility determinations for an applicant to participate in a 1915(c) HCBS program, and, when applicable, annual and change of status assessments for participants currently participating in a 1915(c) HCBS program, using state-approved standardized assessment tool(s). Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules. Required Qualifications Registered Nurse (NC or Compact license) Minimum of two years of nursing experience. Travel up to a 60 mile radius. Preferred Qualifications Experience with community-based individuals needing personal assistance with ADL and IADL tasks. Experience conducting PCS assessments. 2+ years of home healthcare experience. 2+ years of directly-related experience (preferably case management) in the health or medical field, directly related to homecare, long‑term care, or personal care. Experience conducting HCBS waiver assessments. 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 Personal Care Services, home and community-based services (HCBS) programs, and 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 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. Attention to detail, effective prioritization and timely execution of tasks. Ability to work independently without a high degree of supervision. Develop level of care recommendations based upon clinical evaluations. Participate in training of PCS stakeholders as needed. Use person-centered thinking and planning, and demonstrate competency in awareness of the needs of persons with disabilities. Knowledge of North Carolina Medicaid Clinical Policy 3K‑1 and 3K‑2, and 42 CFR Part 441 Subpart G, 42 CFR 440.180. Knowledge of eligibility criteria for LOC and Waiver Participation. Knowledge of standards of practice related to Medicaid waivers, home and community-based services (HCBS) programs, EPSDT, medical fragility, and level of care determinations. Participate in training of CAP stakeholders as needed. Benefits Comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more. Pay Range USD $67,300.00 – USD $93,050.00 per year. #J-18808-Ljbffr Acentra Health