Clinical Assessor - RN (Hybrid in NC \ Travel Required)

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. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem‑solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector. Job Summary and Responsibilities Acentra Health is looking for a Clinical Assessor to join our growing team. The PCS Program: Provides services to NC Medicaid beneficiaries with a medical condition, cognitive impairment, or disability who need hands‑on assistance with activities of daily living. The assessor completes needs‑based eligibility determinations for those applying for Medicaid‑funded personal care services in their homes or in adult care or supervised living homes. The CAP Program: Offers home and community‑based waivers to provide cost‑neutral alternatives to institutionalization for beneficiaries at risk if specialized waiver services are unavailable. The assessor completes needs‑based assessments of level of care to keep individuals in community settings. Assessments are generally performed in the beneficiary’s primary residence. *Position is hybrid. Candidates should be based within Cabarrus County of North Carolina (Concord & surrounding cities) to be able to cover the field work involved. Responsibilities Conduct assessments to determine if the beneficiary meets conditions and criteria for PCS eligibility using state‑approved standardized assessment tools. Ensure PCS are provided on a "needs basis" in quantities appropriate to the beneficiary’s unmet need for services, based on medical condition, functional disability, physical or cognitive impairment. Ensure privacy and dignity of individuals receiving PCS assessments at the highest standards. Complete new, expedited, annual, change of status, mediation/appeals, reconsideration review, and derivative assessments within established timeframes. Include an interview with family members and informal caregivers present at the assessment. Provide the beneficiary with guidance and assistance to select PCS providers. Conduct service plan reviews as needed. Submit completed assessments using the 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, and internal auditing as assigned. Conduct assessments for initial eligibility determinations for applicants to participate in a 1915(c) HCBS program, and, when applicable, annual and change of status assessments for current participants, using state‑approved standardized assessment tools. Ensure CAP services are provided on a "needs basis" in quantities appropriate to the beneficiary’s unmet need, based on medical condition, functional disability, physical or cognitive impairment. Ensure privacy and dignity of individuals receiving assessment for CAP participation at the highest standards. Consult with the beneficiary’s selected case management entity to generate an approvable service plan. Ensure that the randomly selected service plan completed by the beneficiary’s assigned case management entity is appropriate to the beneficiary’s unmet need. Read, understand, and adhere to all corporate policies including HIPAA and its Privacy and Security Rules. Qualifications Required Qualifications Registered Nurse (NC or Compact license) Minimum of two years of nursing experience. Ability to travel up to a 60‑mile radius. Preferred Qualifications Experience with community‑based individuals needing personal assistance with ADL and IADL tasks is highly preferred. Experience conducting PCS assessments highly preferred. 2+ years of home healthcare experience preferred. 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 is preferred. Experience conducting HCBS waiver assessments highly preferred. 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 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. 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. Participates in training of CAP stakeholders as needed. Benefits Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include 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 /Yr. #J-18808-Ljbffr Acentra Health