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Healthcare Evaluator

2 months ago

Hickory, North Carolina, United States Acentra Health Full time


Acentra Health is dedicated to enhancing health outcomes through innovative technology, comprehensive services, and clinical expertise. Our mission is to create health solutions that maximize value and impact.
We invite you to embrace our mission, engage in problem-solving, and take ownership of your daily responsibilities.

Acentra Health is currently seeking a Healthcare Evaluator to join our expanding team.



Position Overview:
Acentra Health is looking for healthcare evaluators across North Carolina for a rewarding opportunity. This role allows you to work from your home office while traveling to various assessment sites in your designated area.

As part of the Personal Care Services (PCS) program, we provide services to NC Medicaid beneficiaries who have medical conditions, cognitive impairments, or disabilities that require assistance with essential daily living activities.

The PCS Evaluator is tasked with conducting needs-based eligibility assessments for North Carolinians applying for Medicaid-funded personal care services, which are delivered in their homes or in adult care facilities.

Under the Community Alternatives (CAP) Program, we offer home and community-based waivers as cost-effective alternatives to institutional care for beneficiaries at risk of institutionalization without specialized waiver services.

These services are designed for individuals whose medical, psychosocial, and functional needs cannot be met by family members, caregivers, or community resources.

The CAP Evaluator is responsible for performing needs-based assessments of the level of care (LOC) to facilitate the ability of individuals to remain in or return to community settings.

Assessments are typically conducted in the beneficiary's primary residence.

Key Responsibilities:

- Conduct assessments to determine PCS eligibility using state-approved standardized tools.

- Ensure that PCS are allocated based on the beneficiary's unmet needs, considering the severity of their medical condition and functional limitations.

- Maintain the highest standards of privacy and dignity for individuals undergoing assessments.

- Complete various assessments within established timeframes, including new, expedited, annual, and change of status assessments.

- Engage with family members and informal caregivers present during assessments.

- Provide guidance to beneficiaries in selecting appropriate PCS providers.

- Review service plans as necessary and submit completed assessments through state-approved interfaces.

- Participate in mediation and appeal processes as required.

- Attend staff meetings and contribute to case consultations and internal audits as assigned.

- Conduct assessments for initial eligibility determinations for participation in 1915(c) HCBS programs, including annual and change of status assessments.

- Ensure CAP services are provided based on the beneficiary's needs and maintain the highest standards of privacy and dignity.

- Collaborate with the beneficiary's selected case management entity to develop approvable service plans.

- Ensure that service plans are appropriate for the beneficiary's needs.

- Respond to state inquiries regarding assessments and actively participate in team meetings.

The list of responsibilities is not exhaustive and may be expanded to include other relevant duties as deemed necessary by management.


Qualifications:
- Registered Nurse or LCSW license in North Carolina.

- A minimum of 2 years of experience in a home care setting is preferred.



Preferred Experience:
- Experience working with community-based individuals requiring assistance with daily living tasks is highly preferred.

- Previous experience conducting PCS assessments is highly desirable.

- At least 2 years of relevant experience in case management within the health or medical field, particularly in homecare or long-term care, is required.

- Familiarity with HCBS waiver assessments is highly preferred.

- Knowledge of North Carolina Medicaid Clinical Coverage Policy and standards related to Medicaid-funded services is essential.

- Proficiency in Microsoft Excel, Word, and Outlook is required.

- Strong communication skills and the ability to interact effectively with healthcare professionals, patients, and their families are necessary.

- Ability to work independently and manage tasks efficiently.

- Commitment to person-centered thinking and understanding the needs of individuals with disabilities.

Why Acentra Health? We are a collaborative team of experienced leaders, clinicians, and industry professionals dedicated to redefining healthcare expectations. Our commitment to improving health outcomes is reflected in our supportive work environment.

We appreciate your interest in Acentra Health and encourage you to explore future opportunities with us.

Best of luck in your job search