PCS Assessor, RN

Job Description:

• 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