RN Clinical Assessor

*This position requires travel in the field across Cumberland/Robeson and surrounding counties. Mileage expenses are reimbursed. 

This position supports the North Carolina Medicaid Linking individuals & Families for Long Term Services and Supports (NC LIFTSS) project. NC LIFTSS was created to streamline access to LTSS programs. It covers a variety of services:

• Process referrals and perform option counseling
• Conduct assessments and quality assurance reviews
• Provide service plan management and customer service
• Conduct provider training for the State Plan Personal Care Services (PCS) program

This exciting role requires you to travel within your region to conduct assessments, as well as, work out of your home office when needed. This offers flexibility in your weekly schedule. As part of the Personal Care Services (PCS) program, you'll provide vital services to NC Medicaid Beneficiaries with medical conditions, cognitive impairments, or disabilities, ensuring they receive the hands-on assistance they need for daily living activities (ADLs).
As a PCS Home Health Registered Nurse, you'll play a crucial role in determining needs-based eligibility for Medicaid-funded personal care services, whether in-home, adult care, or supervised living homes. This role is documentation-intensive to meet the needs of beneficiaries. Join us in this rewarding opportunity to help our community thrive and make a significant impact on the lives of those in need.

What you’ll need:

• Registered Nurse, licensed by the state of North Carolina
• Minimum of two years’ experience in home care setting is required.
• Computer proficiency in Microsoft Excel, Word and Outlook and the ability to utilize computer equipment and web-based software to conduct work is required
• Experience with community-based individuals needing personal assistance with ADL and IADL tasks is highly preferred.
• Experience conducting PCS assessments highly preferred.
• Experience with OASIS tool (or similar) highly preferred.
• Knowledge of North Carolina Medicaid Clinical Coverage Policy (Clinical Policy) 3L and PCS Program Provider Manual highly desired
• Knowledge of standards of practice related to Medicaid-funded Personal Care Services, home and community-based services (HCBS) programs, and EPSDT highly desired

What you’ll do:

• Conducts assessment to determine whether the beneficiary meets 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 impairment.
• Ensures that the privacy and dignity of individuals receiving assessment for PCS is maintained at the highest standards.
• Ensures 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.
• Develops level of care recommendations based upon clinical evaluations.
• Participates in training of PCS stakeholders as needed.
• Read, understand, and adhere to all corporate policies, including policies related to HIPPA and its Privacy and Security Rules.

Skills & Abilities:

• Insightful Understanding of public sector services and supports.
• Interact and Collaborate with various office staff as needed to support necessary workflows, as well as healthcare professionals, patients, their families and other supports.
• Effective Communication to individuals and groups through spoken, written and electronic media.
• Attention to Detail and Highly Organized in documentation to effectively prioritize and execute tasks in a timely manner.
• Person-Centered thinking, planning, and competency in awareness of the needs of persons with disabilities.

Attention Applicants: Please be advised that proper email communication will only be sent from email addresses ending in @astyra.com. Please ensure you are communicating with approved Astyra recruiters by checking this point when receiving offers and messages from us. It is important to communicate within our guidelines and proper channels to expedite possible interview considerations.
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