RN - PCS Assessment Specialist (Remote NC)

Vaya Health; Dobson (NC); Remote; USD 60,000 - 75,000; Full time

Job summary

Vaya Health in North Carolina is seeking a Personal Care Services Assessor Registered Nurse to perform needs-based assessments and eligibility determinations for Medicaid beneficiaries in home or community settings. You will schedule assessments, conduct telephonic and face-to-face interviews, coordinate with prescribers, and submit SARs while protecting privacy and dignity.

The role requires NC RN licensure, a Bachelor's in nursing or healthcare field, and the ability to travel within assigned

Qualifications

• Knowledge of NC 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, and EPSDT
• Knowledge 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 to support workflows
• Ability to interact with healthcare professionals, patients and families
• Ability to communicate effectively to individuals and groups
• Ability to attend to detail, prioritize and execute tasks
• 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
• Ability to use person-centered thinking, planning, and awareness of needs of persons with disabilities

Responsibilities

• Schedule assessments with members and families
• Determine PCS eligibility using standardized assessment tools
• Interview family members and informal caregivers
• Ensure assessments are conducted within established timeframes
• Perform expedited assessments over the phone as needed
• Provide education to select PCS providers
• Work with prescribers and other healthcare professionals to ensure requests are accurate and complete
• Submit service authorization requests (SARs) for PCS providers
• Maintain privacy and dignity of individuals receiving assessment
• Participate in mediation and appeal processes as needed
• Respond to state inquiries regarding assessments
• Attend staff meetings and conduct case consultations/peer reviews

Skills

Clinical assessments

Medicaid policy

Public sector

Communication skills

Detail oriented

Independent work

Care planning

Training PCS stakeholders

Person-centered thinking

Disability awareness

Education

Bachelor's degree in Nursing or healthcare field

Tools

Microsoft Excel

Microsoft Word

Outlook

Job description

Vaya Health in North Carolina is seeking a Personal Care Services Assessor Registered Nurse to perform needs-based assessments and eligibility determinations for Medicaid beneficiaries in home or community settings. You will schedule assessments, conduct telephonic and face-to-face interviews, coordinate with prescribers, and submit SARs while protecting privacy and dignity.

The role requires NC RN licensure, a Bachelor's in nursing or healthcare field, and the ability to travel within assigned