PCS Assessor Registered Nurse (Western NC)
Company: Vaya Health
Location: North Wilkesboro
Posted on: April 24, 2024
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Job Description:
LOCATION: Remote - must live in North Carolina or within 40 miles
of the NC border. This position will cover counties in Western
North Carolina. Must have ability to travel as needed to those
counties. GENERAL STATEMENT OF JOBThe Personal Care Services (PCS)
Assessor Registered Nurse is responsible for completing needs-based
assessments/eligibility determinations for Medicaid-beneficiaries
in Vaya's region who are applying for State Plan Personal Care
Services provided in their home or in adult care or supervised
living homes. These Medicaid-beneficiaries have a medical
condition, cognitive impairment, or disability and demonstrate
unmet needs for hands-on assistance with qualifying activities of
daily living (ADLs). The PCS Assessor Registered Nurse is
responsible for scheduling appointments, administering telephonic
and face-to-face assessments in beneficiaries' home and community,
working with healthcare professionals, and submitting service
authorization requests (SARs) on behalf of PCS providers. ESSENTIAL
JOB FUNCTIONSPCS Assessment and Collaboration:Works with members,
family members, and/or other healthcare professionals to schedule
assessments.Conducts assessment to determine whether the member
meets the conditions and criteria for PCS eligibility, using
standardized assessment tool(s).Conducts interviews with family
members and informal caregivers who are present at the time of the
assessment.Ensures that assessments are conducted within
established timeframes.Performs expedited assessments over the
phone as needed.Provides education and assistance to the member, as
necessary, to select PCS providers.Works with prescribers and/or
other healthcare professionals to ensure that requests are accurate
and complete.Submits service authorization requests (SARs) on
behalf of PCS provider.Ensures that the privacy and dignity of
individuals receiving assessment for PCS is maintained at the
highest standards.Participates in mediation and appeal processes,
as needed.Responds to state inquiries regarding assessments
conducted. Other duties as assigned:Attend and actively participate
in staff meetings and conduct case consultations/peer
reviews/internal auditing as assigned.
KNOWLEDGE, SKILL & ABILITIES:Knowledge of North Carolina Medicaid
Clinical Coverage Policy (Clinical Policy) 3L and PCS Program
Provider ManualKnowledge of standards of practice related to
Medicaid-funded State Plan Personal Care Services, home and
community-based services (HCBS) programs, and Early and Periodic
Screening, Diagnostic and Treatment (EPSDT).Knowledge and
understanding of public sector services and supports.Computer
proficiency in Microsoft Excel, Word and Outlook.Ability to utilize
computer equipment and web-based software to conduct work.Ability
to interact with various office staff as needed to support
necessary workflows.Ability to interact with healthcare
professionals, patients, their families and other supports.Ability
to communicate effectively to individuals and groups through
spoken, written and electronic media.Ability to attend to detail,
effectively prioritize and execute tasks in a timely manner.Ability
to work independently without a high degree of supervision.Develops
level of care recommendations based upon clinical
evaluations.Participates in training of PCS stakeholders as
needed.Ability to use person-centered thinking, planning, and have
competency in awareness of the needs of persons with disabilities.
PHYSICAL REQUIREMENTS:Close visual acuity to perform activities
such as preparation and analysis of documents; viewing a computer
terminal; and extensive reading. Physical activity in this position
includes crouching, reaching, walking, talking, hearing and
repetitive motion of hands, wrists and fingers. Sedentary work with
lifting requirements up to 10 pounds, sitting for extended periods
of time. Mental concentration is required in all aspects of work.
QUALIFICATIONS & EDUCATION REQUIREMENTSBachelor's degree in Nursing
or other healthcare field required and two years of experience in
home care setting. Experience with community-based individuals
needing personal assistance with ADL and IADL tasks is highly
preferred. Experience conducting PCS assessments highly preferred.
Licensure/Certification Required:Must have active licensure in
North Carolina as a Registered Nurse (RN).
RESIDENCY REQUIREMENT:This position is required to reside in North
Carolina or within 40 miles of the North Carolina border.
SALARY: Depending on qualifications & experience of candidate. This
position is exempt and is not eligible for overtime
compensation.
DEADLINE FOR APPLICATION: Open Until Filled
APPLY: Vaya Health accepts online applications in our Career
Center, please visit .
Vaya Health is an equal opportunity employer.
Keywords: Vaya Health, Hickory , PCS Assessor Registered Nurse (Western NC), IT / Software / Systems , North Wilkesboro, North Carolina
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