Acentra Health Nursing Jobs and Careers

Clinical Assessor RN (Remote + Required Travel)

Company Overview: Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector. Job Summary and Responsibilities: Acentra Health is looking for a Clinical Assessor to join our growing team. Job Summary: Acentra Health is seeking clinical assessors statewide in North Carolina for an exciting opportunity. You work out of your home office and travel to assessment locations in your region. Under the Personal Care Services (PCS) program, services are provided to NC Medicaid Beneficiaries who have a medical condition, cognitive impairment, or disability who demonstrate unmet needs for hands-on assistance with qualifying activities of daily living (ADLs). The PCS Assessor is responsible for the completion of needs-based eligibility determinations for North Carolinians who are applying for these Medicaid-funded personal care services provided in their home or in adult care or supervised living homes. Under the Community Alternatives (CAP) Program, home and community-based waivers provide cost-neutral alternatives to institutionalization for Beneficiaries, in specified target populations, who would be at risk for institutionalization if specialized Waiver services are not available. Services are intended for situations where no household member, relative, caregiver, landlord, community agency, volunteer agency, or third-party payer is able or willing to meet the assessed and required medical, psychosocial, and functional needs of the approved CAP Beneficiary. The CAP/PCS Assessor is responsible for completion of needs-based assessments of level of care (LOC) to allow targeted individuals to remain in or return to a home and community-based setting. Assessments are generally performed in the beneficiary’s primary residence. *Position is hybrid. Candidates should be based within Cabarrus County of North Carolina (Concord & surrounding cities) to be able to cover the field work involved. Responsibilities: Conducts assessment to determine whether the beneficiary meets the conditions and criteria for PCS eligibility, using state-approved standardized assessment tool(s). Ensures that PCS are provided on a "needs basis" in quantities appropriate to the Beneficiary's unmet need for services based on the severity of their medical condition, functional disability, physical, or cognitive impairment. Ensures that the privacy and dignity of individuals receiving assessment for PCS is maintained at the highest standards. Ensures that new, expedited, annual, change of status, mediation/appeals, reconsideration review, and derivative assessments are conducted within established timeframes. Include an interview with family members and informal caregivers who are present at the time of the assessment. Provide the Beneficiary with guidance and assistance, as necessary, to select PCS providers. Conduct service plan reviews as needed. Submit the completed assessments using state-approved interface Participate in the Beneficiary’s mediation and appeal processes. Respond to state inquiries regarding assessments conducted. Attend and actively participate in staff meetings and conduct case consultations/peer reviews/internal auditing as assigned. Provide assessments for initial eligibility determinations for an applicant to participate in a 1915(c) HCBS program, and, when applicable, annual and change of status assessments for participant currently participating in a 1915(c) HCBS program, using state-approved standardized assessment tool(s). Ensures that CAP services are provided on a "needs basis" in quantities appropriate to the Beneficiary's unmet need for services based on the severity of their medical condition, functional disability, physical, or cognitive impairment. Ensures that the privacy and dignity of individuals receiving assessment for CAP participation is maintained at the highest standards. Consult, when necessary, with the Beneficiary’s selected case management entity to generate an approvable service plan. Ensure that the randomly selected Service Plan completed by the Beneficiary’s assigned case management entity is appropriate to the Beneficiary’s unmet need for services, based on the severity of their medical condition, functional disability, physical, or cognitive impairment. Include an interview with family members and informal caregivers who are present at the time of the assessment. Submit the completed assessments using state-approved interface Participate in the Beneficiary’s mediation and appeal processes. Respond to state inquiries regarding assessments conducted. Attend and actively participate in staff meetings and conduct case consultations/peer reviews/internal auditing as assigned. Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules. The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time. Qualifications: Required Qualifications Registered Nurse (NC or Compact license) Minimum of two years of nursing experience. This position requires travel up to a 60 mile radius. Preferred Qualifications Experience with community-based individuals needing personal assistance with ADL and IADL tasks is highly preferred. Experience conducting PCS assessments highly preferred. 2+ years of home healthcare experience preferred. 2+ years of directly-related experience (preferably case management) in the health or medical field, directly related to homecare, long-term care, or personal care is preferred. Experience conducting HCBS waiver assessments highly preferred. 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 Personal Care Services, home and community-based services (HCBS) programs, and 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. Knowledge of North Carolina Medicaid Clinical Policy 3K-1 and 3K-2, and 42 CFR Part 441 Subpart G, 42 CFR § 440.180. Knowledge of eligibility criteria for LOC and Waiver Participation. Knowledge of standards of practice related to Medicaid waivers, home and community-based services (HCBS) programs, EPSDT, medical fragility, and level of care determinations. Participates in training of CAP stakeholders as needed. Why us? We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes. We do this through our people. You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career. Benefits Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more. Experience in Lieu of Degree For non-clinical roles, or when not required by the contract specifically, the Company acknowledges that practical, hands-on experience can provide skills and competencies equivalent to formal education. As such, in cases where a Bachelor's degree may be required, the Company will accept a minimum of six (6) years of directly relevant professional experience in lieu of a degree. In instances where the candidate has an Associate's degree, the Company will accept a minimum of three (3) years of directly relevant professional experience in lieu of the Bachelor's degree. Compensation The pay range for this position is listed below. “Based on our compensation philosophy, an applicant’s position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.” Thank You! We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search! ~ The Acentra Health Talent Acquisition Team Visit us at https://careers.acentra.com/jobs EEO AA M/F/Vet/Disability Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law. Pay Range: USD $67,300.00 - USD $93,050.00 /Yr.

RN

Full-time

6 days ago

Clinical Care Coordinator - RN

Acentra Health FL

Company Overview: Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the company’s mission, actively engage in problem-solving, and take ownership of your work daily. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector. Job Summary and Responsibilities: Acentra is looking for a Clinical Care Coordinator RN (Remote within Florida) to join our growing team. Job Summary As a Clinical Care Coordinator RN, you will play a pivotal role in ensuring seamless care coordination and advocacy for patients enrolled in the care management program. In this role, you will act as a trusted patient advocate, facilitating immediate communication between patients and providers to ensure timely access to necessary care and resources. Leveraging your clinical expertise, you will conduct comprehensive medical record reviews, applying appropriate criteria in alignment with contract requirements. Utilizing critical thinking and sound decision-making, you will assess medical necessity while maintaining productivity goals and quality assurance standards. Additionally, you will ensure compliance with NCQA, URAC, and other regulatory guidelines, contributing to the highest standards of patient care. *To qualify for this position, candidates must reside and work remotely within the State of Florida. The work schedule is Monday through Friday from 8:00 AM to 5:00 PM Eastern Time. Candidates must also have access to reliable, high speed internet and a dedicated, private, and secure home workspace that supports productivity and confidentiality. Responsibilities Ensure the responsible and comprehensive delivery of services to enrollees, supporting high-quality patient care. Conduct initial assessments for supervisor/lead evaluation to determine appropriate case manager or health coach assignments. Actively participate in interdisciplinary team meetings, collaborating on assessments and care coordination to ensure optimal patient outcomes. Proactively contribute to quality management program activities, supporting the Health Services team in delivering high-performance outcomes. Assist in achieving and maintaining accreditations for designated programs by ensuring compliance with regulatory standards. Provide education, guidance, and resources to beneficiaries, families, and providers to promote informed healthcare decisions. Review and interpret patient records, applying established criteria to assess medical necessity and appropriateness of care. Determine approval or escalate cases to a physician consultant when necessary, ensuring all decisions—including denials—are clearly documented with sufficient rationale. Accurately abstract and document case data and medical information using appropriate review tools in a timely manner. Ensure the accurate and timely submission of all administrative and review-related documentation to the appropriate parties. Conduct ongoing reassessments of the review process, identifying opportunities for improvement and implementing necessary changes. Build and maintain positive, professional relationships with internal and external stakeholders to facilitate effective care coordination. Stay up to date by attending training sessions and scheduled meetings, applying the latest policies and procedures in clinical reviews. Maintain strict confidentiality of medical records by adhering to HIPAA regulations, using secure systems, and safeguarding sensitive information. Utilize professional communication—both verbal and written—following Acentra Health's policies, procedures, and guidelines. Actively cross-train to support other contracts within the Acentra Health network, ensuring a flexible workforce that adapts to client and consumer needs. The list of responsibilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary. Qualifications: Required Qualifications/Experience: Must have an active, unrestricted Registered Nurse (RN) Florida state license and/or Compact State Clinical license. 2+ years of pediatric experience, demonstrating expertise in pediatric care. Graduate of an accredited nursing program resulting in a diploma, associate, bachelor’s, or master’s degree in nursing. Strong clinical assessment and critical thinking skills, enabling effective patient evaluation and care coordination. This role requires fingerprinting for the state of Florida. Valid driver's license (Occasional driving within the State of Florida may be requested but not required). Preferred Qualifications/Experience: Proficiency with computer systems, including care management applications, internet-based tools, and Microsoft Office applications such as Word and Excel. Experience in medical record abstraction and review, including knowledge of medical record organization, medical terminology, and disease processes. Knowledge of public sector health coverage systems, including Medicare and Medicaid. Knowledge of current URAC and NCQA standards, compliance requirements, and best practices. Excellent verbal and written communication skills, including proficiency in telephonic interviewing and the ability to effectively engage patients, providers, and other stakeholders. Comprehensive understanding of care management principles, ethics, service delivery standards, and patient-centered customer service practices. Strong organizational and prioritization skills, with the ability to manage workloads efficiently while maintaining quality standards. Ability to accept and apply feedback professionally to support continuous improvement in performance and productivity. Why us? We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes. We do this through our people. You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career. Benefits Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more. Experience in Lieu of Degree For non-clinical roles, or when not required by the contract specifically, the Company acknowledges that practical, hands-on experience can provide skills and competencies equivalent to formal education. As such, in cases where a Bachelor's degree may be required, the Company will accept a minimum of six (6) years of directly relevant professional experience in lieu of a degree. In instances where the candidate has an Associate's degree, the Company will accept a minimum of three (3) years of directly relevant professional experience in lieu of the Bachelor's degree. Thank You! We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search! ~ The Acentra Health Talent Acquisition Team Visit us at https://careers.acentra.com/jobs EEO AA M/F/Vet/Disability Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law. Compensation The pay range for this position is listed below. “Based on our compensation philosophy, an applicant’s position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.” Pay Range: Up to USD $36.49/Hr.

RN

Travel

3 weeks ago

Clinical Assessor - RN (Hybrid - Travel Required) - PRN

Acentra Health Charlotte, NC

Company Overview: Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector. Job Summary and Responsibilities: Acentra Health is looking for a Clinical Assessor to join our growing team. Job Summary: Acentra Health is seeking clinical assessors statewide in North Carolina for an exciting opportunity. You work out of your home office and travel to assessment locations in your region. Under the Personal Care Services (PCS) program, services are provided to NC Medicaid Beneficiaries who have a medical condition, cognitive impairment, or disability who demonstrate unmet needs for hands-on assistance with qualifying activities of daily living (ADLs). The PCS Assessor is responsible for the completion of needs-based eligibility determinations for North Carolinians who are applying for these Medicaid-funded personal care services provided in their home or in adult care or supervised living homes. Under the Community Alternatives (CAP) Program, home and community-based waivers provide cost-neutral alternatives to institutionalization for Beneficiaries, in specified target populations, who would be at risk for institutionalization if specialized Waiver services are not available. Services are intended for situations where no household member, relative, caregiver, landlord, community agency, volunteer agency, or third-party payer is able or willing to meet the assessed and required medical, psychosocial, and functional needs of the approved CAP Beneficiary. The CAP/PCS Assessor is responsible for completion of needs-based assessments of level of care (LOC) to allow targeted individuals to remain in or return to a home and community-based setting. Assessments are generally performed in the beneficiary’s primary residence. *Position is hybrid. Candidates should be based within Mecklenburg County, NC (Charlotte) to be able to cover the field work involved. Responsibilities: Conducts assessment to determine whether the beneficiary meets the conditions and criteria for PCS eligibility, using state-approved standardized assessment tool(s). Ensures that PCS are provided on a "needs basis" in quantities appropriate to the Beneficiary's unmet need for services based on the severity of their medical condition, functional disability, physical, or cognitive impairment. Ensures that the privacy and dignity of individuals receiving assessment for PCS is maintained at the highest standards. Ensures that new, expedited, annual, change of status, mediation/appeals, reconsideration review, and derivative assessments are conducted within established timeframes. Include an interview with family members and informal caregivers who are present at the time of the assessment. Provide the Beneficiary with guidance and assistance, as necessary, to select PCS providers. Conduct service plan reviews as needed. Submit the completed assessments using state-approved interface Participate in the Beneficiary’s mediation and appeal processes. Respond to state inquiries regarding assessments conducted. Attend and actively participate in staff meetings and conduct case consultations/peer reviews/internal auditing as assigned. Provide assessments for initial eligibility determinations for an applicant to participate in a 1915(c) HCBS program, and, when applicable, annual and change of status assessments for participant currently participating in a 1915(c) HCBS program, using state-approved standardized assessment tool(s). Ensures that CAP services are provided on a "needs basis" in quantities appropriate to the Beneficiary's unmet need for services based on the severity of their medical condition, functional disability, physical, or cognitive impairment. Ensures that the privacy and dignity of individuals receiving assessment for CAP participation is maintained at the highest standards. Consult, when necessary, with the Beneficiary’s selected case management entity to generate an approvable service plan. Ensure that the randomly selected Service Plan completed by the Beneficiary’s assigned case management entity is appropriate to the Beneficiary’s unmet need for services, based on the severity of their medical condition, functional disability, physical, or cognitive impairment. Include an interview with family members and informal caregivers who are present at the time of the assessment. Submit the completed assessments using state-approved interface Participate in the Beneficiary’s mediation and appeal processes. Respond to state inquiries regarding assessments conducted. Attend and actively participate in staff meetings and conduct case consultations/peer reviews/internal auditing as assigned. Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules. The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time. Qualifications: Required Qualifications Registered Nurse (NC or Compact license) Minimum of two years of nursing experience. This position requires travel up to a 60 mile radius. Preferred Qualifications Experience with community-based individuals needing personal assistance with ADL and IADL tasks is highly preferred. Experience conducting PCS assessments highly preferred. 2+ years of home healthcare experience preferred. 2+ years of directly-related experience (preferably case management) in the health or medical field, directly related to homecare, long-term care, or personal care is preferred. Experience conducting HCBS waiver assessments highly preferred. 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 Personal Care Services, home and community-based services (HCBS) programs, and 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. Knowledge of North Carolina Medicaid Clinical Policy 3K-1 and 3K-2, and 42 CFR Part 441 Subpart G, 42 CFR § 440.180. Knowledge of eligibility criteria for LOC and Waiver Participation. Knowledge of standards of practice related to Medicaid waivers, home and community-based services (HCBS) programs, EPSDT, medical fragility, and level of care determinations. Participates in training of CAP stakeholders as needed. Why us? We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes. We do this through our people. You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career. Benefits Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more. Thank You! We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search! ~ The Acentra Health Talent Acquisition Team Pay Range: USD $67,300.00 - USD $93,050.00 /Yr.

Clinical Assessor, - RN (Hybrid/Travel) Wake County, NC

Acentra Health Raleigh, NC

Company Overview: Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector. Job Summary and Responsibilities: Acentra Health is looking for a Clinical Assessor to join our growing team. Job Summary: The purpose of this position is to complete needs-based eligibility determinations for patients who are applying for Medicaid-funded personal care services provided in their home or in adult care or supervised living homes. This position also assesses level of care (LOC) to allow targeted individuals to remain in or return to a home and community-based setting. *Position is hybrid. Candidates should be based within Wake County of North Carolina (Raleigh & surrounding cities) to be able to cover the field work involved. Responsibilities: Conduct assessments to determine whether the beneficiary meets the conditions and criteria for PCS eligibility, using state-approved standardized assessment tool(s). Ensure PCS are provided on a "needs basis" in quantities appropriate to the Beneficiary's unmet need for services based on the severity of their medical condition, functional disability, physical, or cognitive impairment. Ensure the privacy and dignity of individuals receiving assessment for PCS is maintained at the highest standards. Ensure that new, expedited, annual, change of status, mediation/appeals, reconsideration review, and derivative assessments are conducted within established timeframes. Include an interview with family members and informal caregivers who are present at the time of the assessment. Provide the Beneficiary with guidance and assistance, as necessary, to select PCS providers. Conduct service plan reviews as needed. Submit the completed assessments using state-approved interface. Participate in the Beneficiary's mediation and appeal processes. Respond to state inquiries regarding assessments conducted. Attend and actively participate in staff meetings and conduct case consultations/peer reviews/internal auditing as assigned. Provide assessments for initial eligibility determinations for an applicant to participate in a 1915(c) HCBS program, and, when applicable, annual and change of status assessments for participants currently participating in a 1915(c) HCBS program, using state-approved standardized assessment tool(s). Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules. Qualifications: Required Qualifications Registered Nurse (NC or Compact license) Minimum of two years of nursing experience. This position requires travel up to a 60 mile radius. Preferred Qualifications Experience with community-based individuals needing personal assistance with ADL and IADL tasks is highly preferred. Experience conducting PCS assessments highly preferred. 2+ years of home healthcare experience preferred. 2+ years of directly-related experience (preferably case management) in the health or medical field, directly related to homecare, long-term care, or personal care is preferred. Experience conducting HCBS waiver assessments highly preferred. 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 Personal Care Services, home and community-based services (HCBS) programs, and 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. Knowledge of North Carolina Medicaid Clinical Policy 3K-1 and 3K-2, and 42 CFR Part 441 Subpart G, 42 CFR § 440.180. Knowledge of eligibility criteria for LOC and Waiver Participation. Knowledge of standards of practice related to Medicaid waivers, home and community-based services (HCBS) programs, EPSDT, medical fragility, and level of care determinations. Participates in training of CAP stakeholders as needed. Why us? We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes. We do this through our people. You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career. Benefits Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more. Thank You! We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search! ~ The Acentra Health Talent Acquisition Team Pay Range: USD $67,300.00 - USD $93,050.00 /Yr.

RN

2 months ago

PRN - RN Clinical Assessor (Aged & Disabled Waiver)

Acentra Health Charleston, WV

Company Overview: Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector. Job Summary and Responsibilities: Acentra Health is looking for a PRN - RN Clinical Assessor (Aged & Disabled Waiver) to join our growing team. Job Summary: This position educates and performs medical eligibility assessments of WV Medicaid recipients seeking community-based services and follows prescribed guidelines while administering the Pre-Admission Screening for determination of medical eligibility for the Aged & Disabled Waiver Program. RN Clinical Assessors must manage a caseload of assigned members to ensure that assessments are scheduled, appropriate persons are in attendance, assessments are performed, and data is entered into Atrezzo within prescribed timelines. This position requires extensive local travel within an assigned catchment area as well as periodic travel outside a catchment area. *This is a hybrid role based in West Virginia, combining remote work from home with field assessments and quarterly in-office meetings. Applicants should reside in Kanawha or Putnam County for best coverage of field work required. Responsibilities: Document contacts, schedule appointments, travel to conduct and appropriately administer/document Pre-Admission Screening assessments within prescribed timelines. Participate in inter-rater reliability activities to ensure consistent administration of assessments and adherence to assessment protocols Participate in denial hearings as necessary. Contact physicians and facilities to confirm medical information. Conduct assessments to determine whether the beneficiary meets the conditions and criteria for ADW eligibility, using state-approved standardized assessment tool(s). Ensure ADW are provided on a "needs basis" in quantities appropriate to the Beneficiary's unmet need for services based on the severity of their medical condition, functional disability, physical, or cognitive impairment. Ensure the privacy and dignity of individuals receiving assessment for ADW is maintained at the highest standards. Ensure that new, expedited, annual, change of status, mediation/appeals, reconsideration review, and derivative assessments are conducted within established timeframes. Include an interview with family members and informal caregivers who are present at the time of the assessment. Provide the Beneficiary with guidance and assistance, as necessary, to select ADW providers. Conduct service plan reviews as needed. Submit the completed assessments using state-approved interface. Participate in the Beneficiary's mediation and appeal processes. Respond to state inquiries regarding assessments conducted. Attend and actively participate in staff meetings and conduct case consultations/peer reviews/internal auditing as assigned. Provide assessments for initial eligibility determinations for an applicant to participate in a 1915(c) HCBS program, and, when applicable, annual and change of status assessments for participants currently participating in a 1915(c) HCBS program, using state-approved standardized assessment tool(s). Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules. Qualifications: Required qualifications: Valid, unrestricted Registered Nurse (RN) license for the state of West Virginia or compact license Must have a valid driver's license and access to reliable transportation Willingness to travel to homes and facilities within the catchment area (travel outside one's catchment area is occasionally required to fill-in for others or to attend staff meetings/events) Candidate should be organized and have excellent customer service skills, good interpersonal communication and be flexible Applicant must be able to accurately assess medical conditions and symptoms and functional abilities Applicant must possess computer skills, specifically with Microsoft Outlook, Microsoft Word, Microsoft Edge, Google Chrome Preferred qualifications: Two years of experience in a home care setting Two years of experience with the aging population or with persons with disabilities (preferably working within the WV Aged and Disabled Waiver Program) Knowledge of the Aged and Disabled Waiver program policies and procedures Why us? We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes. We do this through our people. You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career. Benefits Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more. Thank You! We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search! ~ The Acentra Health Talent Acquisition Team Visit us at https://careers.acentra.com/jobs EEO AA M/F/Vet/Disability Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law. Experience in Lieu of Degree For non-clinical roles, or when not required by the contract specifically, the Company acknowledges that practical, hands-on experience can provide skills and competencies equivalent to formal education. As such, in cases where a Bachelor's degree may be required, the Company will accept a minimum of six (6) years of directly relevant professional experience in lieu of a degree. In instances where the candidate has an Associate's degree, the Company will accept a minimum of three (3) years of directly relevant professional experience in lieu of the Bachelor's degree. Compensation The pay range for this position is listed below. “Based on our compensation philosophy, an applicant’s position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.” #LI-AF1 Pay Range: USD $33.00 - USD $35.00 /Hr.