PCS Assessor RN (Alamance/Chatham/Caswell)

Vaya Health; North Carolina; Hybrid; USD 68,000 - 88,000; Full time

Job summary

Vaya Health is seeking a PCS Assessor Registered Nurse to perform needs-based Medicaid assessments for home-based services across Alamance, Chatham and Caswell counties in NC. The role requires NC RN licensure and residency within NC or within 40 miles of the NC border; travel to counties is required.

The position is remote with required NC residency and serves multiple counties. You will schedule assessments, conduct both phone and in-person visits, and work with healthcare professionals to

Qualifications

• Bachelor’s degree in Nursing or healthcare field required.
• Active RN licensure in North Carolina required.
• Experience conducting PCS assessments preferred.

Responsibilities

• Schedules assessments with members, families, and providers.
• Conducts needs-based PCS assessments, in home or telephonically.
• Submits SARs on behalf of PCS providers and coordinates with prescribers.
• Maintains privacy and dignity of individuals during assessments.
• Attends meetings and participates in case reviews and audits.

Skills

NC Medicaid policies

Effective communication

Interpersonal skills

Assessment coordination

Team collaboration

Education

Bachelor’s degree in Nursing or healthcare field

Tools

Microsoft Excel

Microsoft Word

Microsoft Outlook

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

PCS Assessor RN (Alamance/Chatham/Caswell)

Full Time Salaried Professional Alamance County, Burlington, NC, US

3 days ago Requisition ID: 3345

Salary Range: $68,033.34 To $88,443.35 Annually

LOCATION:

Remote – must live in or near Alamance County, Chatham County, Caswell County North Carolina. The person in this role is required to maintain residency in North Carolina or within 40 miles of the NC border. This position will serve Alamance County, NC, Chatham County, NC, and Caswell County, NC. Must have ability to travel as needed to those counties

GENERAL STATEMENT OF JOB

The Personal Care Services (PCS) Assessor Registered Nurse is responsible for completing needs-based assessments/eligibility determinations for Medicaid-beneficiaries in Vaya Partners regions who are applying for State Plan Personal Care Services provided in their home or in adult care or supervised living homes. These Medicaid-beneficiaries have a medical condition, cognitive impairment, or disability and demonstrate unmet needs for hands-on assistance with qualifying activities of daily living (ADLs). The PCS Assessor Registered Nurse is responsible for scheduling appointments, administering telephonic and face-to-face assessments in beneficiaries home and community, working with healthcare professionals, and submitting service authorization requests (SARs) on behalf of PCS providers.

ESSENTIAL JOB FUNCTIONS

PCS Assessment and Collaboration

• Works with members, family members, and/or other healthcare professionals to schedule assessments.
• Conducts assessment to determine whether the member meets the conditions and criteria for PCS eligibility, using standardized assessment tool(s).
• Conducts interviews with family members and informal caregivers who are present at the time of the assessment.
• Ensures that assessments are conducted within established timeframes.
• Performs expedited assessments over the phone as needed.
• Provides education and assistance to the member, as necessary, to select PCS providers.
• Works with prescribers and/or other healthcare professionals to ensure that requests are accurate and complete.
• Submits service authorization requests (SARs) on behalf of PCS provider.
• Ensures that the privacy and dignity of individuals receiving assessment for PCS is maintained at the highest standards.
• Participates in mediation and appeal processes, as needed.
• Responds to state inquiries regarding assessments conducted.

Other duties as assigned

Including, but not limited to, attending and actively participating in staff meetings and conducting case consultations/peer reviews/internal auditing as assigned.

KNOWLEDGE, SKILLS, & ABILITIES

• Knowledge of North Carolina Medicaid Clinical Coverage Policy (Clinical Policy) 3L and PCS Program Provider Manual
• Knowledge of standards of practice related to Medicaid-funded State Plan Personal Care Services, home and community-based services (HCBS) programs, and Early and Periodic Screening, Diagnostic and Treatment (EPSDT).
• Knowledge and understanding of public sector services and supports.
• 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 PCS stakeholders as needed.
• Ability to use person-centered thinking, planning, and have competency in awareness of the needs of persons with disabilities.

PHYSICAL REQUIREMENTS

Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading. Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists and fingers. Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time. Mental concentration is required in all aspects of work.

EDUCATION & EXPERIENCE REQUIREMENTS

Bachelor’s degree in Nursing or other healthcare field required and two years of experience in home care setting. Experience with community-based individuals needing personal assistance with ADL and IADL tasks is highly preferred. Experience conducting PCS assessments highly preferred.

Licensure/Certification Required:

Must have active licensure in North Carolina as a Registered Nurse (RN).

RESIDENCY REQUIREMENT:

The person in this position is required to reside in North Carolina or within 40 miles of the North Carolina border.

SALARY:

Depending on qualifications & experience of candidate. This position is exempt and is not eligible for overtime compensation.

Vaya Partners is an equal opportunity employer.