PCS Assessor, RN
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Job Description
Registered Nurse conducting Medicaid personal-care eligibility assessments for Vaya Partners. Scheduling visits, evaluating ADL needs, and submitting service authorizations across four North Carolina counties.
Responsibilities:
- Complete needs-based assessments and eligibility determinations for Medicaid beneficiaries applying for State Plan Personal Care Services
- Schedule telephonic and face-to-face assessments with members, families, caregivers, and healthcare professionals
- Conduct assessments in beneficiaries’ homes and community settings using standardized assessment tools
- Interview family members and informal caregivers
- Complete assessments within established timeframes
- Perform expedited assessments by phone as needed
- Educate and assist members in selecting PCS providers
- Collaborate with prescribers and healthcare professionals to ensure requests are accurate and complete
- Submit service authorization requests (SARs) on behalf of PCS providers
- Maintain the privacy and dignity of individuals receiving PCS assessments
- Participate in mediation and appeal processes
- Respond to state inquiries regarding completed assessments
- Attend and participate in staff meetings
- Conduct case consultations, peer reviews, and internal auditing as assigned
- Develop level-of-care recommendations based on clinical evaluations
- Participate in training PCS stakeholders as needed
Requirements:
- Bachelor’s degree in Nursing or other healthcare field required
- Two years of experience in a home care setting
- Active licensure in North Carolina as a Registered Nurse (RN) required
- Experience with community-based individuals needing personal assistance with ADL and IADL tasks highly preferred
- Experience conducting PCS assessments highly preferred
- Knowledge of North Carolina Medicaid Clinical Coverage 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 and understanding of public sector services and supports
- Computer proficiency in Microsoft Excel, Word, and Outlook
- Ability to use computer equipment and web-based software
- Ability to communicate effectively through spoken, written, and electronic media
- Ability to work independently without a high degree of supervision
- Ability to use person-centered thinking, planning, and competency in awareness of the needs of persons with disabilities
- Must reside in North Carolina or within 40 miles of the North Carolina border
- Ability to travel as needed to Rockingham, Forsyth, Surry, and Stokes counties
Benefits:
- Salary depending on qualifications and experience
- Exempt position not eligible for overtime compensation
- Equal opportunity employer
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