Clinical Assessor (RN - Hybrid)

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 and Responsibilities Acentra Health is looking for a Clinical Assessor to join our growing team. The position is hybrid. Candidates should be based within Granville and Vance County of North Carolina to be able to cover the field work involved. Job Summary: We seek clinical assessors statewide in North Carolina for an exciting opportunity. You work out of your home office and travel to assessment locations in your region. Under the Personal Care Services (PCS) program, services are provided to NC Medicaid Beneficiaries who have a medical condition, cognitive impairment, or disability. The PCS Assessor is responsible for the completion of needs-based eligibility determinations for North Carolinians who are applying for Medicaid-funded personal care services. Under the Community Alternatives (CAP) Program, home and community-based waivers provide cost‑neutral alternatives to institutionalization for Beneficiaries at risk of institutionalization. Responsibilities Conduct assessment to determine whether the beneficiary meets the conditions and criteria for PCS eligibility, using state-approved standardized assessment tool(s). Ensure that 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 that 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 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. 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). Consult, when necessary, 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 for services. Read, understand, and adhere to all corporate policies including those related to HIPAA and its Privacy and Security Rules. The list of accountabilities is not intended to be all‑inclusive and may be expanded to include other duties that management deems necessary from time to time. Required Qualifications Registered Nurse or LCSW license by the applicable state. Minimum of two years of nursing experience. This position requires 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. Two or more years of home healthcare experience. Two or more years of directly related experience in case management in the health or medical field. Experience conducting HCBS waiver assessments. Knowledge of North Carolina Medicaid Clinical Coverage Policy 3L and the 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 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 office staff, healthcare professionals, patients, families, and other supports. Strong communication skills—spoken, written, and electronic. Attention to detail, effective prioritization, and task execution within timely deadlines. 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 demonstrate awareness of the needs of persons with disabilities. Knowledge of North Carolina Medicaid Clinical Policy 3K‑1, 3K‑2, and 42 CFR Part 441 Subpart G and 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 Benefits are a key component of your rewards package. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more. Compensation The pay for this position is listed below. $80,000 per year. Based on our compensation philosophy, an applicant’s position placement in the pay range will depend on various considerations such as years of applicable experience and skill level. Pay range: USD $77,000.00 – USD $80,000.00 per year. Equal Opportunity Employment EEO AA M/F/Vet/Disability Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law. #J-18808-Ljbffr Acentra Health