Personal Care Assistance; PCA RN assessor

Position: Personal Care Assistance (PCA) RN assessor
Job Summary Contractor
- Personal Care Assistance (PCA) RN assessor:
This field-based position is responsible for performing in-home assessments for PCA services using established guidelines and tools to ensure appropriate level of care and services are authorized. Responsibilities:
Assesses for PCA services in the patient’s homes evaluating clinical need against established guidelines and/or standards to ensure that the services provided are medically appropriate and aligned with benefit structure. Meets minimum metric requirement of 5 PCA assessments/day. Evaluates the necessity, appropriateness and efficiency of service provided. Coordinates and assists in implementation of services to meet the needs of the members.

Coordinates with patient, family, physician, hospital and other external customers with respect to the appropriateness of care from diagnosis to outcome. Coordinates the delivery of high quality, cost-effective care supported by clinical practice guidelines established by the plan addressing the entire continuum of care. Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services provided.

Refers members to MLTSS when appropriate. Documents accurately and comprehensively based on the standards of practice and current organization policies. Interacts and communicates with multidisciplinary teams either telephonically and/or in person, including legal for Medical Fair Hearing testimony, striving for continuity and efficiency as the member is managed along the continuum of care. Understands fiscal accountability and its impact on the utilization of resources, proceeding to self-care outcomes.

Evaluates care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomes. Completes other assigned functions as requested by management. Performs duties as assigned by management. Education/

Experience:

High School Diploma/GED required. Bachelor degree preferred or relevant experience in lieu of degree. A minimum of two (2) years clinical experience is preferred. Additional licensing, certifications, registrations:
Active Unrestricted NJ RN License Required. Knowledge:
Proficiency in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint); prefers knowledge in the use of intranet and internet applications. Working knowledge of case/care management principles. Working knowledge of principles of utilization management. Prefers basic knowledge of health care contracts and benefit eligibility requirements. Prefers knowledge of hospital structures and payment systems.

Skills and Abilities:

Analytical Compassionate Interpersonal & Client Relationship Building Skills Sound Decision Making Active Listening Organization/Planning/Priority Setting Problem Solving/Critical Thinking Team Player Time Management Written/Oral Communication Skills (Bi-lingual preferred) Travel (If Applicable ):
This is a field-based position, daily travel is required (mileage reimbursement provided). Requires a car with valid New Jersey State License and Insurance. .