PCS Assessor RN (Buncombe/Henderson/Polk/Rutherford/Madison/WNC)

Vaya Health; Mill Spring (NC); Remote; USD 65,000 - 90,000; Full time

Job summary

Vaya Health is seeking a Personal Care Services (PCS) Assessor Registered Nurse to conduct needs-based assessments for Medicaid beneficiaries in the North Carolina region. The role includes scheduling visits, performing telephonic and in-home assessments, coordinating with prescribers and PCS providers, and submitting service authorization requests while maintaining patient privacy.

Qualified candidates hold a NC RN license, a Bachelor’s degree in Nursing or a related field, and at least two

Qualifications

• Bachelor's degree in Nursing or healthcare field.
• Active licensure in North Carolina as a Registered Nurse (RN).
• Two years of experience in home care setting; PCS assessments preferred.

Responsibilities

• Schedule assessments with members and families.
• Conduct needs-based assessments for PCS eligibility.
• Interview family members and informal caregivers.
• Complete assessments within established timeframes; expedite by phone if needed.
• Educate members on PCS providers and options.
• Submit SARs for PCS providers; maintain privacy and dignity.
• Respond to state inquiries and participate in appeals as needed.
• Attend staff meetings and case consultations.

Skills

Medicaid policy knowledge

Communication skills

Computer proficiency

Detail oriented

Independent worker

Education

Bachelor's degree in Nursing or healthcare

Tools

MS Excel

MS Word

Outlook

Job description

LOCATION

Remote - must live in or near Buncombe County, Henderson County, Polk County, Rutherford County, or Madison 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 Buncombe County, NC, Henderson County, NC, Polk County, NC, Rutherford County, NC, Madison County, NC and will occasionally travel to serve other western North Carolina counties through Cherokee County. 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.

DEADLINE FOR APPLICATION

Open Until Filled

Vaya Partners is an equal opportunity employer.