PCS Assessor, RN

Job not on LinkedIn

🔥 1 minute ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $68k - $88.4k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 1%

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Vaya Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1972

🛡️ Insurance

💼 Consulting

📦 Logistics

Insurance • Consulting • Logistics

Vaya Health is a North Carolina-based organization that manages services for individuals with behavioral health issues, including mental health and substance use disorders, intellectual and developmental disabilities (I/DD), and traumatic brain injuries (TBI). The organization provides Medicaid services tailored for these populations, focusing on a person-centered approach that connects members to the necessary care and support for their unique health and wellness goals. Vaya Health emphasizes collaboration across various care areas to ensure comprehensive support for its members, fostering healthier communities across the region.

📋 Description

• Complete needs-based assessments and eligibility determinations for Medicaid beneficiaries applying for State Plan Personal Care Services • Schedule telephonic and face-to-face assessments in beneficiaries’ homes and communities • Conduct standardized PCS eligibility assessments and interviews with family members and informal caregivers • Complete expedited assessments by phone when needed • Provide education and assistance to members selecting PCS providers • Collaborate with prescribers and healthcare professionals to ensure requests are accurate and complete • Submit service authorization requests on behalf of PCS providers • Maintain the privacy and dignity of individuals receiving PCS assessments • Participate in mediation and appeal processes • Respond to state inquiries regarding completed assessments • Attend staff meetings and conduct case consultations, peer reviews, and internal audits as assigned • Develop level-of-care recommendations based on clinical evaluations • Participate in training PCS stakeholders as needed

🎯 Requirements

• Must live in or near Buncombe, Henderson, Polk, Rutherford, or Madison County, North Carolina • Must reside in North Carolina or within 40 miles of the North Carolina border • Ability to travel as needed to covered counties and other western North Carolina counties through Cherokee County • Bachelor’s degree in Nursing or another healthcare field required • Two years of experience in a home care setting • Active North Carolina Registered Nurse (RN) licensure required • Experience with community-based individuals needing personal assistance with ADL and IADL tasks highly preferred • Experience conducting PCS assessments highly preferred • Knowledge of North Carolina Medicaid Clinical Coverage Policy 3L and PCS Program Provider Manual • Knowledge of Medicaid-funded State Plan Personal Care Services, HCBS programs, and EPSDT • Knowledge of public sector services and supports • Proficiency in Microsoft Excel, Word, and Outlook • Ability to use computer equipment and web-based software • Ability to communicate effectively with office staff, healthcare professionals, patients, families, and other supports • Ability to prioritize tasks, attend to detail, and work independently • Ability to use person-centered thinking and demonstrate awareness of the needs of persons with disabilities • Ability to perform sedentary work, sit for extended periods, and lift up to 10 pounds

🏖️ Benefits

• Equal opportunity employer • Exempt position; not eligible for overtime compensation