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. 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 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, North Carolina to cover the field work involved. 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 who demonstrate unmet needs for hands‑on assistance with qualifying activities of daily living (ADLs). The PCS Assessor is responsible for the completion of needs‑based eligibility determinations for North Carolinians who apply for these Medicaid‑funded personal care services. Under the Community Alternatives (CAP) Program, home and community‑based waivers provide cost‑neutral alternatives to institutionalization for Beneficiaries who would be at risk for institutionalization if specialized Waiver services are not available. The CAP/PCS Assessor is responsible for completion of needs‑based assessments of level of care (LOC) to allow targeted individuals to remain in or return to a home and community‑based setting. Assessments are generally performed in the beneficiary’s primary residence. Responsibilities Conduct assessment to determine whether the beneficiary meets the conditions and criteria for PCS eligibility, using state‑approved standardized assessment tools. 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. Maintain the privacy and dignity of individuals receiving assessment for PCS 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 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 tools. Ensure that CAP services 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. Maintain the privacy and dignity of individuals receiving assessment for CAP participation at the highest standards. 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, based on the severity of their medical condition, functional disability, physical, or cognitive impairment. Read, understand and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules. Required Qualifications Registered Nurse or Licensed Clinical Social Worker (LCSW) license in the applicable state. 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. More than 2 years of home healthcare experience. More than 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 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 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. Develop level of care recommendations based upon clinical evaluations. Participate in training of PCS stakeholders as needed. 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. Participate in training of CAP stakeholders as needed. Benefits Our benefits package includes comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more. Compensation USD $77,000.00 – USD $80,000.00 per year. EEO Statement 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