Clinical Assessor-PRN

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. We are seeking 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 Community Alternatives (CAP) Program, home and community-based waivers provide cost-neutral alternatives to institutionalization for Beneficiaries, in specified target populations, who would be at risk for institutionalization if specialized Waiver services are not available.

Services are intended for situations where no household member, relative, caregiver, landlord, community agency, volunteer agency, or third-party payer is able or willing to meet the assessed and required medical, psychosocial, and functional needs of the approved CAP Beneficiary. The CAP Assessor is responsible for the completion of needs-based eligibility determinations for North Carolinians who are applying for these Medicaid-funded personal care services provided in their home or in adult care or supervised living homes.

The CAP 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.

Daily tasks include processing CAP SRFs (services referral forms). If there are inquiries related to SRF processing, initiate RAIs (Requests for Additional Information) exclusively for SRFs that have been pending for three days or less. In cases where an SRF is missing the required information, issue a Technical Denial (TD) and document the reasons in the communication log. Monitor the CAP SRF queue each day to comply with the contract's stipulation of a maximum of 14 business days in the queue.

Prior to processing SRFs, check for potential duplicate beneficiaries. Additionally, complete CAP SRF 2nd level when necessary.

Position is hybrid. Candidates should be based within Durham County of North Carolina to be able to cover the field work involved. This position is PRN.

• 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 participant currently participating in a 1915(c) HCBS program, using state-approved standardized assessment tool(s).
• This position will complete CAP MDT RN reviews on all finalized CAP assessments. For CAPC, this entails re-evaluating medical fragility focusing on the workflow rationale for SRF approval and assessing the justification for need. CAPDA, in contrast, only mandates the review of reasonable indications of need. Review for Level of Care if indicated for MDTs that do not meet LOC in QiReport.
• Ensures 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.
• Ensures that the privacy and dignity of individuals receiving assessment for CAP participation is maintained 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.
• Include an interview with family members and informal caregivers who are present at the time of the assessment.
• 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.
• Read, understand, and adhere to all corporate policies including policies 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 education- and…