RN Clinical Assessor

Overview This position supports the NC LIFTSS project. NC LIFTSS was created to streamline access to LTSS programs. It covers a variety of services: Process referrals and perform option counseling Conduct assessments and quality assurance reviews Provide service plan management and customer service Conduct provider training for the State Plan Personal Care Services (PCS) program This position requires travel in the field across Cumberland, Robeson and surrounding counties. Mileage expenses are reimbursed. This exciting role requires you to travel within your region to conduct assessments, as well as work out of your home office when needed. This offers flexibility in your weekly schedule. As part of the Personal Care Services (PCS) program, you\'ll provide vital services to NC Medicaid Beneficiaries with medical conditions, cognitive impairments, or disabilities, ensuring they receive the hands-on assistance they need for daily living activities (ADLs). As a PCS Home Health Registered Nurse, you\'ll play a crucial role in determining needs-based eligibility for Medicaid-funded personal care services, whether in-home, adult care, or supervised living homes. This role is documentation-intensive to meet the needs of beneficiaries. Qualifications and responsibilities are described below. What you’ll need (Qualifications) Registered Nurse, licensed by the state of North Carolina Minimum of two years’ experience in home care setting Computer proficiency in Microsoft Excel, Word and Outlook and the ability to utilize computer equipment and web-based software to conduct work Experience with community-based individuals needing personal assistance with ADL and IADL tasks Experience conducting PCS assessments Experience with OASIS tool (or similar) 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 What you’ll do (Responsibilities) Conducts assessment to determine whether the beneficiary meets 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 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. Develops level of care recommendations based upon clinical evaluations. Participates in training of PCS stakeholders as needed. Read, understand, and adhere to all corporate policies, including policies related to HIPAA and its Privacy and Security Rules. Skills & Abilities Insightful Understanding of public sector services and supports. Interact and Collaborate with various office staff as needed to support necessary workflows, as well as healthcare professionals, patients, their families and other supports. Effective Communication to individuals and groups through spoken, written and electronic media. Attention to Detail and Highly Organized in documentation to effectively prioritize and execute tasks in a timely manner. Person-Centered thinking, planning, and competency in awareness of the needs of persons with disabilities. #J-18808-Ljbffr