Clinical Assessor

Job Summary

Astyra is seeking a skilled Clinical Assessor to join our team in North Carolina. As a Clinical Assessor, you will work out of your home office and travel to assessment locations in your region. Under the Personal Care Services (PCS) program, services are provided to NC Medicaid Beneficiaries who have a medical condition, cognitive impairment, or disability who demonstrate unmet needs for hands-on assistance with qualifying activities of daily living (ADLs).

Key Responsibilities

Conduct assessments to determine whether the beneficiary meets the 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 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.

Requirements

Registered Nurse, licensed by the state of North Carolina
Minimum of two years experience in home care setting preferred.
Experience with community-based individuals needing personal assistance with ADL and IADL tasks is highly preferred.
Experience conducting PCS assessments highly preferred.

Skills and Knowledge

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 and Outlook.
Ability to utilize computer equipment and web-based software to conduct work.
Ability to interact with various office staff as needed to support necessary workflows.
Ability to interact with healthcare professionals, patients, their families and other 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 a high degree of supervision.
Develops level of care recommendations based upon clinical evaluations.
Participates in training of PCS stakeholders as needed.
Ability to use person-centered thinking, planning, and have competency in awareness of the needs of persons with disabilities.