RN Clinical Assessor; Personal Care

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.

Acentra Health is looking for a RN Clinical Assessor (Personal Care) to join our growing team.

Job Summary:

This position educates and performs medical eligibility assessments of WV Medicaid recipients seeking community-based services and follows prescribed guidelines while administering the Pre-Admission Screening for determination of medical eligibility for the Personal Care Program and the Aged & Disabled Waiver Program. Personal Care RNs must manage a caseload of assigned members to ensure that assessments are scheduled, appropriate persons are in attendance, assessments are performed, and data is entered into Care Care Connection within prescribed timelines.

This position requires extensive local travel within an assigned catchment area as well as periodic travel outside a catchment area.

* This is a hybrid role based in West Virginia, combining remote work from home with field assessments and quarterly in-office meetings. Applicants should reside in Monongalia, Ohio, Wetzel, Marshall, Marion, Hancock or Brooke County for best coverage of field work required.

Responsibilities:

• Document contacts, schedule appointments, travel to conduct and appropriately administer/document Pre-Admission Screening assessments within prescribed timelines
• Participate in inter-rater reliability activities to ensure consistent administration of assessments and adherence to assessment protocols Participate in denial hearings as necessary
• Contact physicians and facilities to confirm medical information
• Conduct assessments to determine whether the beneficiary meets the conditions and criteria for PCS eligibility, using state-approved standardized assessment tool(s)
• Ensure 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
• Ensure the privacy and dignity of individuals receiving assessment for PCS is maintained at the highest standards
• Ensure that new, expedited, annual, change of status, mediation/appeals, reconsideration review, and derivative assessments are conducted within established time frames
• 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
• Submit the completed assessments using state-approved interface
• Participate in the Beneficiary's mediation and appeal processes
• 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

Required qualifications:

• Valid, unrestricted Registered Nurse (RN) license for the state of West Virginia or compact license
• Associate of Science in Nursing (ASN) degree from an accredited college/university (BSN preferred)
• Must have a valid West VA driver's license and access to reliable transportation
• Willingness to travel to homes and facilities within the catchment area (travel outside one's catchment area is occasionally required to fill-in for others or to attend staff meetings/events)
• Candidate should be organized and have excellent customer service skills, good interpersonal communication and be flexible
• Applicant must be able to accurately assess medical conditions…