PCS Assessor, RN
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Job Description
Remote PCS Assessor RN evaluating Medicaid beneficiaries’ personal care needs for Vaya Partners. Conducting home, community, telephonic, and face-to-face assessments across western North Carolina.
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 in beneficiaries’ homes and communities
- Conduct standardized PCS eligibility assessments and interviews with family members and informal caregivers
- Complete expedited assessments by phone when needed
- Provide education and assistance to members selecting PCS providers
- Collaborate with prescribers and healthcare professionals to ensure requests are accurate and complete
- Submit service authorization requests 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 staff meetings and conduct case consultations, peer reviews, and internal audits as assigned
- Develop level-of-care recommendations based on clinical evaluations
- Participate in training PCS stakeholders as needed
Requirements:
- Must live in or near Buncombe, Henderson, Polk, Rutherford, or Madison County, North Carolina
- Must reside in North Carolina or within 40 miles of the North Carolina border
- Ability to travel as needed to covered counties and other western North Carolina counties through Cherokee County
- Bachelor’s degree in Nursing or another healthcare field required
- Two years of experience in a home care setting
- Active North Carolina Registered Nurse (RN) licensure 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 Medicaid-funded State Plan Personal Care Services, HCBS programs, and EPSDT
- Knowledge of public sector services and supports
- Proficiency in Microsoft Excel, Word, and Outlook
- Ability to use computer equipment and web-based software
- Ability to communicate effectively with office staff, healthcare professionals, patients, families, and other supports
- Ability to prioritize tasks, attend to detail, and work independently
- Ability to use person-centered thinking and demonstrate awareness of the needs of persons with disabilities
- Ability to perform sedentary work, sit for extended periods, and lift up to 10 pounds
Benefits:
- Equal opportunity employer
- Exempt position; not eligible for overtime compensation
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