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.

Acentra Health is looking for a Clinical Assessor to join our growing team.

• Conduct assessment to determine whether the beneficiary meets 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 severity of medical condition, functional disability, physical, or cognitive impairment.
• Maintain privacy and dignity of individuals receiving assessment for PCS at highest standards.
• Conduct new, expedited, annual, change of status, mediation/appeals, reconsideration review, and derivative assessments within established time frames.
• Include interview with family members and informal caregivers present at time of assessment.
• Provide beneficiary with guidance and assistance to select PCS providers.
• Conduct service plan reviews as needed.
• Submit completed assessments using state-approved interface.
• Participate in 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.
• Read, understand, and adhere to all corporate policies including HIPAA and Privacy and Security Rules.
• Accountabilities are not intended to be all-inclusive and may be expanded by management.

Required Qualifications

• Registered Nurse or LCSW license by applicable state.
• Minimum two years of nursing experience.
• Position requires 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 case management in health or medical field 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, Outlook.
• Ability to utilize computer equipment and web-based software for work.
• Ability to interact with various office staff and healthcare professionals, patients, families, and 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 high supervision.
• Develop level of care recommendations based upon clinical evaluations.
• Participates in training of PCS and CAP stakeholders as needed.
• 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, HCBS programs, EPSDT, medical fragility, and level of care determinations.

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

Benefits provide protection, security, and support for career and life. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

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.

The pay for this position is listed below. After 90 days, the salary will increase to…