- 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.
- 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.
- 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.
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PCS Assessor Registered Nurse - Louisburg, United States - Vaya Health
Description
LOCATION: Remote – must live in North Carolina or within 40 miles of the NC border. This position will cover the Eastern and Coastal areas in North Carolina. 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's region 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:
Other duties as assigned:
Attend and actively participate in staff meetings and conduct case consultations/peer reviews/internal auditing as assigned.
KNOWLEDGE, SKILL & ABILITIES:
PHYSICAL REQUIREMENTS:
QUALIFICATIONS & EDUCATION 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:
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.
