RN Clinical Reviewer - CAP (Community Alternatives Program)

Astyra 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 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.

Accountabilities

• 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 participants 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 impairment.
• Ensures that the privacy and dignity of individuals receiving assessment for CAP participation are 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 the 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.

• Registered Nurse, licensed by the state of North Carolina,
• Minimum of two (2) years of directly-related experience (preferably case management) in the health or medical field, directly related to home care, long-term care, or person care is required.
• Experience conducting HCBS Waiver Assessments is highly preferred

• 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.
• 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 with 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 the 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.

 
Proper email communication will only be done to and from @astyra.com email addresses. Please ensure you are communicating with approved Astyra recruiters by checking this point when receiving offers and messages from us. Please ensure you are communicating within these guidelines and proper channels for the quickest possible interview consideration!
#AC