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Clinical Assessor

2 months ago

Hickory, North Carolina, United States KEPRO Full time
Job Summary:

Acentra Health is seeking a skilled Clinical Assessor to join our team in North Carolina. As a Clinical Assessor, you will be responsible for conducting needs-based eligibility determinations for North Carolinians applying for Medicaid-funded personal care services. You will work out of your home office and travel to assessment locations in your region.

Key Responsibilities:
  • Conduct assessments to determine whether beneficiaries meet the conditions and criteria for PCS eligibility, using state-approved standardized assessment tools.
  • 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.
  • Maintain the privacy and dignity of individuals receiving assessment for PCS at the highest standards.
  • Conduct new, expedited, annual, change of status, mediation/appeal, and reconsideration reviews within established timeframes.
  • Include an interview with family members and informal caregivers who are present at the time of the assessment.
  • Provide beneficiaries with guidance and assistance, as necessary, to select PCS providers.
  • Conduct service plan reviews as needed.
  • Submit completed assessments using state-approved interfaces.
  • Participate in beneficiary 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 or LCSW license by the state of North Carolina.
  • 2+ years of experience in home care settings preferred.
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 directly-related experience (preferably case management) in the health or medical field, directly related to homecare, long-term care, or personal care is required.
  • 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, 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.
  • Knowledge of North Carolina Medicaid Clinical Policy 3K-1 and 3K-2, and 42 CFR Part 441 Subpart G, 42 CFR §.
  • Knowledge of eligibility criteria for LOC and Waiver Participation.
  • Knowledge of standards of practice related to Medicaid waivers, home and community-based services (HCBS) programs, EPSDT, medical fragility, and level of care determinations.
  • Participates in training of CAP stakeholders as needed.