Job Description:

CNSI and Kepro are now Acentra Health! 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 company's mission, actively engage in problem-solving, and take ownership of your work daily. 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.Acentra Health seeks 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 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). The PCS 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.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 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.Job Responsibilities:Conducts assessment to determine whether the beneficiary meets the conditions and criteria for PCS eligibility, using state-approved standardized assessment tool(s)Ensures 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 impairmentEnsures that the privacy and dignity of individuals receiving assessment for PCS is maintained at the highest standardsEnsures that new, expedited, annual, change of status, mediationappeals, reconsideration review, and derivative assessments are conducted within established timeframesInclude an interview with family members and informal caregivers who are present at the time of the assessmentProvide the Beneficiary with guidance and assistance, as necessary, to select PCS providersConduct service plan reviews as neededSubmit the completed assessments using state-approved interfaceParticipate in the Beneficiary's mediation and appeal processesRespond to state inquiries regarding assessments conductedAttend and actively participate in staff meetings and conduct case consultationspeer reviewsinternal auditing as assignedProvide 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)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 impairmentEnsures that the privacy and dignity of individuals receiving assessment for CAP participation is maintained at the highest standardsConsult, when necessary, with the Beneficiary's selected case management entity to generate an approvable service planEnsure 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 impairmentInclude an interview with family members and informal caregivers who are present at the time of the assessmentSubmit the completed assessments using state-approved interfaceParticipate in the Beneficiary's mediation and appeal processesRespond to state inquiries regarding assessments conductedAttend and actively participate in staff meetings and conduct case consultationspeer reviewsinternal auditing as assignedThe 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.Required QualificationsExperience:Registered Nurse or LCSW license by the state of North Carolina2+ years of experience in home care setting preferredPreferred QualificationsExperience:Experience with community-based individuals needing personal assistance with ADL and IADL tasks is highly preferredExperience conducting PCS assessments highly preferred2+ 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 requiredExperience conducting HCBS waiver assessments highly preferredKnowledge of North Carolina Medicaid Clinical Coverage Policy (Clinical Policy) 3L and PCS Program Provider ManualKnowledge of standards of practice related to Medicaid-funded Personal Care Services, home and community-based services (HCBS) programs, and EPSDTKnowledge and understanding of public sector services and supportsComputer proficiency in Microsoft Excel, Word and OutlookAbility to utilize computer equipment and web-based software to conduct workAbility to interact with various office staff as needed to support necessary workflowsAbility to interact with healthcare professionals, patients, their families and other supportsAbility to communicate effectively to individuals and groups through spoken, written and electronic mediaAbility to attend to detail, effectively prioritize and execute tasks in a timely mannerAbility to work independently without a high degree of supervisionDevelops level of care recommendations based upon clinical evaluationsParticipates in training of PCS stakeholders as neededAbility to use person-centered thinking, planning, and have competency in awareness of the needs of persons with disabilitiesKnowledge of North Carolina Medicaid Clinical Policy 3K-1 and 3K-2, and 42 CFR Part 441 Subpart G, 42 CFR440.180Knowledge of eligibility criteria for LOC and Waiver ParticipationKnowledge of standards of practice related to Medicaid waivers, home and community-based services (HCBS) programs, EPSDT, medical fragility, and level of care determinationsParticipates in training of CAP stakeholders as neededWhy 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 nationwide. Our company cares about our employees, giving you the tools and encouragement, you need to achieve the finest work of your career.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 interest you. Best of luck in your search!~ The Acentra Health Talent Acquisition TeamVisit us at careersEOE AA MFVetDisabilityAcentra 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.BenefitsBenefits are a key component of your rewards package. Our benefits are designed to provide additional protection, security, and support for your career and life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and pensationThe pay range for this position is $70,000 - 73,000"Based on our compensation philosophy, an applicant's placement in the pay range will depend on various considerations, such as years of applicable experience and skill level."