Lead Clinical Assessor

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.

Acentra Health is looking for a Lead 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 these 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.

**This is a hybrid position with a mix of remote work and field work. Field work will typically involve home visits but may also be day programs at a facility. Candidates should reside in (a) Henrico County or (b) Northern Virginia [Alexandria, Arlington County, Fairfax County, Falls Church, Loudoun County, Manassas, Manassas Park, and Prince William County].

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
• Trains new associates and provides ongoing training as needed
• Handle high priority provider issues
• Participate in strategic planning
• May create PPT for workshops and webinars
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules

Required qualifications:

• Registered Nurse license for the State of Virginia or compact license (will be required to obtain Virginia license within a year)

• 1+ years of experience in Utilization Review (UR) and/or Prior Authorization or related experience

• 2+ years of experience (preferably case management) in the health or medical field, directly related to homecare, long-term care, or personal care
• 2+ years of experience with community-based individuals needing personal assistance with ADL and IADL tasks

Preferred qualifications:

• Knowledge of standards of practice related to Medicaid waivers, home, and community-based services (HCBS) programs, EPSDT, medical fragility, and level of care determinations
• Develops level of care recommendations based upon clinical evaluations
• Ability to use person-centered thinking, planning, and have competency in awareness of the needs of persons with disabilities
• Ability to interact with healthcare professionals, patients, their families, and other supports.
• Knowledge of InterQual criteria
• Knowledge of current NCQA/URAC standards
• Medical record abstracting skills
• Knowledge of the organization of medical records, medical terminology, and disease process
• Strong clinical assessment and critical thinking skills
• Excellent verbal and written communication skills
• Ability to work in a team environment
• Flexibility and strong organizational skills
• Computer proficiency in Microsoft Excel, Word and Outlook
• Ability to utilize computer equipment and web-based software to conduct work

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.

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."

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