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Clinical Assessor (RN - Hybrid - PRN)
Clinical Assessor (RN - Hybrid - PRN)Acentra Health, LLC • Durham, NC, United States
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Clinical Assessor (RN - Hybrid - PRN)

Clinical Assessor (RN - Hybrid - PRN)

Acentra Health, LLC • Durham, NC, United States
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  • [job_card.full_time]
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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.

Job Summary and Responsibilities

Acentra Health is looking for a Clinical Assessor to join our growing team.

Job Summary :

  • Acentra Health is 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.

Responsibilities :

  • 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 experience-related duties that management may deem necessary from time to time.

    Qualifications

    Required Qualifications

  • Registered Nurse or LCSW license by the applicable state.
  • Minimum of two years of nursing experience.
  • This position requires travel up to a 60 mile radius.
  • Preferred Qualifications

  • Knowledge of North Carolina Medicaid Clinical Policy 3K-1 and 3K-2, and 42 CFR Part 441 Subpart G, 42 CFR § 440.180.
  • Knowledge of eligibility criteria for LOC and Waiver Participation.
  • Minimum of two years' experience in a home care setting preferred.
  • Knowledge of standards of practice related to Medicaid waivers, home and community-based services (HCBS) programs, EPSDT, medical fragility, and level of care determinations.
  • Knowledge and understanding of public sector services and supports.
  • Understanding of services provided under the CAP waivers.
  • 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 CAP stakeholders as needed.
  • Ability to use person-centered thinking, planning, and have competency in awareness of the needs of persons with disabilities.
  • Why us?

    We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

    We do this through our people.

    You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

    Benefits

    Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

    Thank You!

    We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!

    ~ The Acentra Health Talent Acquisition Team

    Visit us at

    EEO AA M / F / Vet / Disability

    Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

    Compensation

    The pay range for this position is listed below.

    "Based on our compensation philosophy, an applicant's position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level."

    Pay Range

    Starting from USD $37.02 / Hr.

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