Clinical Assessor

Clinical Assessor - RN (Hybrid/Travel) - US-NC-Gastonia
Resident Area
Gastonia, North Carolina 28054

Job Summary:

The purpose of this position is to complete needs-based eligibility determinations for patients who are applying for Medicaid-funded personal care services provided in their home or in adult care or supervised living homes. This position also assesses level of care (LOC) to allow targeted individuals to remain in or return to a home and community-based setting.

***This role requires a valid driver's license and travel to various locations, which may include extended periods of driving (up to approximately 8 hours in a day and can drive up to 120 miles a day)***

***Travel expenses—including mileage and parking are covered and reimbursed by Acentra Health. We will provide all necessary technology equipment for your home office, including a laptop for use in the field***

Responsibilities:

· Conduct assessments to determine whether the beneficiary meets the conditions and criteria for PCS eligibility, using state-approved standardized assessment tool(s).

· Ensure 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 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.

· 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 tool(s).

· Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

Required Qualifications

· Registered Nurse licensed by the state of North Carolina or compact.

· This role requires a valid driver's license and travel to various locations, which may include extended periods of driving (up to approximately 8 hours in a day and can drive up to 120 miles a day).

· Travel expenses—including mileage and parking are covered and reimbursed by Acentra Health. We will provide all necessary technology equipment for your home office, including a laptop for use in the field.

· Proficient in computer-based software and tools, including Microsoft Office Suite (Word, Excel, Outlook, Teams).

· Detail-oriented with strong organizational skills and the ability to prioritize and complete tasks efficiently within established timelines.

Preferred Qualifications

· Minimum of 2 experience in a home care setting.