Clinical Assessor

Job Title:   Clinical Assessor
Location:   Raleigh, NC 27617
Duration:   3 months contract to hire

Job Summary:
Our client is seeking a Clinical Assessor, Mid to complete needs-based eligibility determinations for patients applying for Medicaid-funded personal care services (PCS) provided in their homes or in adult care or supervised living homes. The role also assesses level of care (LOC) to support targeted individuals in remaining in or returning to a home- and community-based setting.

 

Key Responsibilities
•    Conduct assessments to determine whether beneficiaries meet the conditions and criteria for PCS eligibility using state-approved standardized assessment tools.
•    Ensure PCS are provided on a needs basis and in quantities appropriate to the beneficiary's unmet needs, considering the severity of medical conditions and functional, physical, or cognitive impairments.
•    Maintain the privacy and dignity of individuals receiving assessments to the highest standards.
•    Complete new, expedited, annual, change-of-status, mediation/appeals, reconsideration review, and derivative assessments within established timeframes.
•    Interview family members and informal caregivers who are present during the assessment.
•    Provide beneficiaries with guidance and assistance, as necessary, to select PCS providers.
•    Conduct service plan reviews as needed.
•    Submit completed assessments using the state-approved interface.
•    Participate in beneficiary mediation and appeal processes.
•    Respond to state inquiries regarding assessments conducted.
•    Attend and actively participate in staff meetings and conduct case consultations, peer reviews, and internal auditing as assigned.
•    Provide assessments for initial eligibility determinations for applicants to participate in a 1915(c) HCBS program and, when applicable, annual and change-of-status assessments for current participants, using state-approved standardized assessment tools.
•    Read, understand, and adhere to all corporate policies, including HIPAA and its Privacy and Security Rules.

 

Required / Preferred Qualifications
•    Registered Nurse (RN) in North Carolina.
•    Minimum of two years of experience in a home care setting preferred.
•    Valid driver's license and ability to travel to various locations.
•    Ability to accommodate extended periods of driving, potentially up to approximately 8 hours in a day.
•    Ability to lift up to 50 pounds.