The Personal Care Services (PCS) Assessor Registered Nurse is responsible for completing needs-based assessments/eligibility determinations for Medicaid-beneficiaries in Alliance'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 face-to-face assessments in members’ home and community, working with healthcare professionals, developing Service Plans, and submitting service authorization requests (SARs) on behalf of PCS providers. 

This position is required to reside in North Carolina or within 40 miles of the North Carolina border. The hire will be required to travel to various sites as needed to conduct assessments and can work from home to complete administrative tasks. No office days are required but will come onsite for required meetings.

Responsibilities & Duties

PCS Assessment and Collaboration

• Works with members, family members, and/or other healthcare professionals to schedule assessments and collaboration to develop Service Plans
• Conducts in-person comprehensive assessment to determine whether the member meets the conditions and criteria for PCS eligibility, using standardized assessment tool(s) 
• Develops Service Plans in alignment with member needs identified in the PCS Assessment
• With member or legally responsible person (LRP) consent, conducts interviews with family members and informal caregivers to obtain needed information to assess the member’s wholistic needs 
• Assess for signs of abuse and neglect; reporting any suspicion of the same in accordance with State and Federal Laws as well as Alliance Policy and Procedures; ensuring plan for member safety
• Accountable to complete PCS Assessments and Service Plans within established timeframes
• Performs expedited assessments in-person; virtual and telephonic can be considered based on member availability and timelines 
• Provides education and assistance to the member or LRP, 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
• In collaboration with Alliance Appeals & Grievances, participates in mediation and appeal processes, as needed
• Collaborates with Primary Care Manager and provides warm hand-off to ensure member Service Plan is incorporated into the Care Plan or ISP
• Facilitates referrals to Community Health Workers, as needed, to support any identified non-health related unmet needs
• Provides and supports Utilization Management to gather and provide additional information to ensure timelines and member needs are met
• Collaborates with Alliance Medical Directors for case consultation when member presents with complex health needs and/or barriers to accessing appropriate services and supports
• Conducts a medication history, medication reconciliation as needed, and facilitates consultation with and connection to prescribers for concerns; as needed, facilitates internal referrals to Alliance Pharmacist for additional medication regimen reviews
• Documents PCS assessments, services plans, and medication histories in the CM Platform system or other State data base systems as required
• Documents notes related to PCS assessment findings in the CM Platform system

 Administrative Functions

• In collaboration with the Supervisor, PCS Assessor monitors and ensures timely assignment of referrals for PCS Assessments
• Attend and actively participate in staff meetings and conduct case consultations/peer reviews/internal auditing as assigned

Minimum Requirements

Education & Experience

Required:

Graduation from an accredited school of nursing and four (4) years of experience in home care setting.

Or

Bachelor’s degree in nursing or other healthcare field required and two (2) years of experience in home care setting.

Must have active licensure in North Carolina as a Registered Nurse (RN).

Preferred:

Experience with community-based individuals needing personal assistance with ADL and IADL tasks is highly preferred.

Experience conducting PCS assessments highly preferred.

Experience with complex behavioral, cognitive, and physical health needs strongly preferred.

Knowledge, Skills, & Abilities

• 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 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.

Salary Range

$66,240 to $88,456/Annually 

Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity.

An excellent fringe benefit package accompanies the salary, which includes:

• Medical, Dental, Vision, Life, Long Term Disability
• Generous retirement savings plan
• Flexible work schedules including hybrid/remote options
• Paid time off including vacation, sick leave, holiday, management leave
• Dress flexibility