Remote RN PCS Assessor — Medicaid Home Care Evaluator

Vaya Health; Asheville (NC); Remote; USD 68,000 - 92,000; Full time

Job summary

Vaya Health is seeking a Registered Nurse to perform needs-based assessments for Medicaid Personal Care Services. This remote role requires NC residency with county-based service areas and travel to western NC counties as needed.

Responsibilities include scheduling, interviewing, completing eligibility assessments, educating members on PCS options, and submitting SARs while maintaining privacy and high standards of care. RN licensure in NC is required.

Qualifications

• 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, HCBS programs, EPSDT
• Public sector services awareness
• Proficiency with Microsoft Excel, Word and Outlook
• Ability to use computer and web-based software for work
• Ability to communicate effectively with individuals and groups
• Attention to detail and timely task execution
• Ability to work independently with minimal supervision
• Develops level of care recommendations based on clinical evaluations
• Supports PCS stakeholders training when needed
• Competence in person-centered thinking for people with disabilities

Responsibilities

• Schedule assessments with members/families/healthcare professionals
• Determine PCS eligibility using standardized assessment tools
• Interview family members and caregivers
• Ensure assessments occur within established timeframes
• Perform expedited assessments by phone as needed
• Educate and assist members in selecting PCS providers
• Coordinate with prescribers to ensure complete requests
• Submit SARs for PCS providers
• Maintain privacy and dignity of beneficiaries
• Participate in mediation/appeal processes as needed
• Respond to state inquiries about assessments
• Attend staff meetings and participate in case consultations/ audits

Skills

Medicaid PCS knowledge

Communication skills

Computer proficiency

Time management

Interpersonal skills

Education

Bachelor's degree in Nursing

Active NC RN license

Tools

Microsoft Excel

Microsoft Word

Outlook

Job description

Vaya Health is seeking a Registered Nurse to perform needs-based assessments for Medicaid Personal Care Services. This remote role requires NC residency with county-based service areas and travel to western NC counties as needed.

Responsibilities include scheduling, interviewing, completing eligibility assessments, educating members on PCS options, and submitting SARs while maintaining privacy and high standards of care. RN licensure in NC is required.