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Clinical Assessor RN (Remote + Required Travel)

$67,300 - $93,050 / year

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.

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.

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

Acentra Health Charlotte, NC

$67,300 - $93,050 / year

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

$67,300 - $93,050 / year

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

Home Health

2 months ago

PRN - RN Clinical Assessor (Aged & Disabled Waiver)

Acentra Health Charleston, WV

$33 - $35 / hour

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.

Clinical Assessor-RN (Hybrid-Travel) Durham, NC (PRN)

Acentra Health Durham, NC

$35 - $37.08 / hour

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. Position is hybrid. Candidates should be based within Durham County of North Carolina to be able to cover the field work involved. This position is PRN. 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 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 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. The CAP 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. Daily tasks include processing CAP SRFs (services referral forms). If there are inquiries related to SRF processing, initiate RAIs (Requests for Additional Information) exclusively for SRFs that have been pending for three days or less. In cases where an SRF is missing the required information, issue a Technical Denial (TD) and document the reasons in the communication log. Monitor the CAP SRF queue each day to comply with the contract's stipulation of a maximum of 14 business days in the queue. Prior to processing SRFs, check for potential duplicate beneficiaries. Additionally, complete CAP SRF 2nd level when necessary. Responsibilities: Your primary role will be completing CAPDA and CAPC comprehensive assessments. You may also receive cross‑training in up to four additional areas, Minimum Hours: 16 Training Requirements: Training may span up to seven (7) consecutive days. Includes up to four (4) days of remote learning followed by three (3) days of field training. Travel Expectations: Travel time for two assessments can be up to 120 miles per day If travel exceeds 120 miles, the schedule will be reduced to one assessment. PRN staff are not scheduled on Saturdays Durham NC and surrounding counties in Region 4 A two‑week advance schedule is required to allow sufficient time for appointment scheduling. 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 or LCSW license by the applicable state. Minimum of two years of nursing experience. This position requires travel up to a 60-mile radius. Preferred Qualifications 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. Minimum of two years' experience in a home care setting preferred. Knowledge of standards of practice related to Medicaid waivers, home and community-based services (HCBS) programs, EPSDT, medical fragility, and level of care determinations. Knowledge and understanding of public sector services and supports. Understanding of services provided under the CAP waivers. 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 CAP stakeholders as needed. Ability to use person-centered thinking, planning, and have competency in awareness of the needs of persons with disabilities. 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 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, gender identity, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law. Compensation “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: USD $35.00 - USD $37.08 /Hr.

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

Acentra Health Charlotte, NC

$67,300 - $80,000 / year

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 of North Carolina (Charlotte & 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. 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 $80,000.00 /Yr.

RN

Full-time

2 months ago

Clinical Care Coordinator - RN (Remote within Florida) Template FL UM/CM

Acentra Health

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 role, you must reside and work remotely from the state of Florida ** ** Work Schedule: Monday through Friday, 8:00 AM – 5:00 PM Eastern ** ** Occasional travel (up to 5% annually) within the State of Florida may be required ** ** Access to a dedicated, private, and secure workspace at home, free from distractions, to ensure productivity and confidentiality. ** ** Access to reliable, high-speed internet service. ** 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 Associate, Bachelor’s, Master’s degree program or a Diploma in Nursing. Valid driver’s license with a clean Motor Vehicle Record (MVR) and reliable transportation for up to 5% annual travel within the state of Florida. Strong clinical assessment and critical thinking skills, enabling effective patient evaluation and care coordination. This role requires fingerprinting for the state of Florida. Preferred Qualifications/Experience: Proficiency in computer systems, including care management applications, internet-based tools, and Microsoft Office (Word, Excel). Experience in medical record abstracting, ensuring accurate and efficient data retrieval. Knowledge and familiarity with public sector health coverage systems (e.g., Medicare/Medicaid). Knowledge of current Utilization Review Accreditation Commission (URAC) standards and compliance requirements. Knowledge of National Committee for Quality Assurance (NCQA) standards and best practices. Excellent verbal and written communication skills, ensuring clear, professional interactions with patients, providers, and stakeholders. Comprehensive understanding of care management principles, ethics, and service delivery standards. Solid prioritization and organizational abilities, managing workload efficiently while maintaining high-quality standards. Knowledge of customer service principles, ensuring a patient-centered approach to care. Proficient telephonic interviewing skills, enabling effective assessments and engagement. Ability to accept and apply feedback professionally, continuously improving performance and productivity. Familiarity with medical record organization, medical terminology, and disease processes, ensuring accuracy in case review and documentation. #LI-SD1 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. 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 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. Visit us at Acentra Health 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.” Pay Range: Up to USD $36.72/Hr.

RN

Full-time

3 months ago

Case Manager RN

Acentra Health OR

$67,300 - $93,050 / year

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 seeks a Case Manager RN to join our growing team. Job Summary: The Case Manager RN will contribute to enhancing the company’s success through personalized care planning, ensuring optimal outcomes and compliance with payer standards. Their collaboration with healthcare team members strengthens the overall effectiveness of care delivery, while their expertise in coordinating diverse beneficiary needs reflects the company's commitment to overall well-being. **This is a remote position within the State of Oregon. Key Responsibilities: Provide care coordination/care management for beneficiaries, ensuring a high level of clinical knowledge and performance by the clinical team Foster a caring philosophy in leadership and all aspects of the care management process Manage the care of beneficiaries through the healthcare system based on their individual needs for social, physical, vision, dental, behavioral, pharmacy, and preventative health services Use independent judgment and discretion to address and proactively resolve barriers impeding diagnostic, social or treatment progress Interact and collaborate with a multidisciplinary care team, including physicians, nurses, case managers, OHA staff, and social workers/educators to ensure as well as participate in IDT meetings beneficiary needs and preferences for health services/information are shared Educate beneficiaries about community resources/options and advocate on behalf of the beneficiary Complete health and social assessments for the purposes of care planning using motivational interviewing, trauma informed care and equity principles for all engagements Establish a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality outcomes Maintain operational requirements for caseload management, securing PHI, working from a plan of care, documentation standards, and other program standards Maintain strict standards for client confidentiality and client-related information Comply with all organizational, state, and federal regulations and policies on confidentiality Prepare documentation, status updates, event notifications, and other documentation regarding beneficiaries in accordance with regulatory requirements and company policies and procedures Monitor case load to ensure all required documentation, plan of care, and entry of assessment results into a web-based database are completed accurately and promptly Pursue ongoing education, certification, and self-development to remain current with case management standards Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules Other duties as assigned Qualifications: Required Qualifications/Experience: Current, active and unrestricted Oregon Registered Nursing license Associate's degree in nursing or bachelor's degree from an accredited college or university 2+ years clinical experience 1+ years case management or home care experience Must reside in Oregon Preferred Qualifications/Experience: Certified Case Manager (CCM) Ability to multi-task and prioritize with variable and sometimes conflicting deadlines Superior attention to detail Demonstrated ability in decision-making Demonstrated initiative and judgment in performance of job responsibilities Maintain professionalism, flexibility and dependability under pressure Strong communication (written/verbal), interpersonal, organizational, time management and communication skills Exceptional customer service skills Ability to foster relationships with internal/external customers and facilitating meetings Ability to work independently and as part of a team Ability to research/identify and apply appropriate standards of care Interest in continuous learning and a commitment to staying informed on regulatory changes 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 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: USD $67,300.00 - USD $93,050.00 /Yr.

RN

Full-time

3 months ago

Clinical Assessor (Field RN)

Acentra Health Raleigh, NC

$67,300 - $80,000 / year

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, Mid 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. 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: Registered Nurse or LCSW license by the applicable state. Minimum of two years' experience in a home care setting preferred. 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. $80k “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 $80,000.00 /Yr.

RN

Per Diem

3 months ago

Clinical Reviewer - RN - PRN (Remote U.S.)

Acentra Health

$28.37 - $36 / hour

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 Reviewer - RN - PRN (Remote U.S.) to join our growing team. Job Summary: Review medical records against criteria, contract requirements, and regulatory standards. Employ critical thinking to determine medical appropriateness while meeting production goals and QA standards. Ensure day-to-day processes align with NCQA, URAC, CMS, and other regulatory benchmarks, ensuring precision and compliance in medical record reviews. Responsibilities: Review and interpret patient records, comparing them against criteria to determine medical necessity and appropriateness of care; assess if the medical record documentation supports the need for services. Initiate a referral to the physician consultant and process physician consultant decisions, ensuring the reason for denial is described in sufficient detail in correspondence. Abstract review-related data/information accurately and promptly using the appropriate means on an appropriate review tool. Ensure accurate and timely submission of all administrative and review-related documents to the company. Perform ongoing reassessment of the review process to identify improvement and/or change opportunities. Foster positive and professional relationships and liaise with internal and external customers to ensure effective working relationships and team building, facilitating the review process. Be responsible for attending training and scheduled meetings and maintaining and using current/updated information for review. Maintain medical records confidentiality by properly using computer passwords, maintaining secured files, and adhering to HIPAA policies. Utilize proper telephone etiquette and judicious use of other verbal and written communications, following company policies, procedures, and guidelines. Actively cross-train to perform duties of other contracts within the company network to provide a flexible workforce to meet client/consumer needs. Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules. The above list of responsibilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary. ** Preferred availability is during business hours (8:00 AM–5:00 PM, Monday–Friday). We can be flexible with scheduling based on individual availability. Occasional weekend coverage may be requested as needed. ** Qualifications: Required Qualifications/Experience: Active, unrestricted Registered Nurse (RN) License in South Carolina, or an RN compact state license. Associate’s, Bachelor's degree (or Diploma) in Nursing. 2+ years of clinical experience in an acute OR med-surgical environment. 1+ years of work experience in Utilization Review (UR), Utilization Management (UM), OR Prior Authorization. 1+ years of knowledge of InterQual criteria. Remote work experience. Preferred Qualifications/Experience: Knowledge of Utilization Review Accreditation Commission (URAC) standards. Knowledge of Medicare (CMS) guidelines. Medical Record Abstracting skills. Clinical assessment and critical thinking skills. Excellent verbal and written communication skills. Ability to work in a team environment. Flexibility and strong organizational skills. Proficient in Microsoft Office and Internet/Web Navigation. #LI-SD1 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. 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 Acentra Health 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. Benefits - PRN This position includes access to select Acentra Health benefits and programs, such as participation in the Acentra Health 401(k) Plan with company match, access to wellness and employee discount programs, and Employee Assistance Program (EAP) resources. 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: USD $28.37 - USD $36.00 /Hr.