Supervisor-PCS Assessor-Registered Nurse (Hybrid, North Carolina Based)

The Supervisor of Personal Care Services (PCS) Assessors provides in-person and virtual oversight to our PCS Assessors who complete 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.

This position is required to reside in North Carolina or within 40 miles of the North Carolina border. The hire will need to travel to various locations as needed to provide oversight of staff conducting assessments. No office days are required but the hire will come onsite for required meetings.

Responsibilities & Duties

PCS Assessment and Collaboration

• Cross covers and observes the PCS Assessor-RN to work with members, family members, and/or other healthcare professionals to schedule assessments and collaboration to develop Service Plans
• Cross covers and observes the PCS Assessor-RN in-person when completing the comprehensive assessment to determine whether the member meets the conditions and criteria for PCS eligibility, using standardized assessment tool(s) and development of PCS Service Plans
• Cross covers and reviews the PCS Assessor-RN to submission of service authorization requests (SARs) on behalf of PCS provider
• Reviews PCS Assessments for clinical accuracy in line with Clinical Coverage Policies and Contractual Requirements\
• Accountable to ensure PCS Assessor reports any suspicion of abuse or neglect in accordance with State and Federal Laws as well as Alliance Policy and Procedures; ensuring plan for member safety
• Reviews PCS Service Plans for completeness and alignment with member needs identified in the PCS Assessment
• Holds PCS Assessor-RN accountable to conduct assessments and develop Service Plans  within established timeframes
• To accommodate expedited requests, performs PCS assessments  virtually, consideration for telephonic based on member availability and timelines
• 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
• 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
• Responds to state inquiries regarding assessments conducted
• Accountable to ensure members referred for PCS assessment are engaged with a primary care manager for ongoing support
• In collaboration with the manager and provider network, supports collaboration with PCS services providers and identifying gaps in provider network adequacy
• Works collaboratively with Utilization Management to ensure timelines and member needs are met 
• Reviews cases to ensure a medication history, medication reconciliation as needed, are completed with facilitation of consultation with and connection to prescribers for concerns; as needed, facilitates internal referrals to Alliance Pharmacist for additional medication regimen reviews

Administrative Functions

• Monitors referrals and timely coordinates assignment to PCS Assessor-RN 
• Remains up to date with any changes in Clinical Coverage Policy 3L, collaborating with manager to ensure operations align with any new or changing requirements
• Attend and actively participate in staff meetings and conduct case consultations/peer reviews/internal auditing as assigned

Manage and Develop Staff

• Work with Human Resources, Director, and Managers to maintain and retain a highly qualified and well-trained workforce
• Develop and maintain the schedule of staff to ensure adequate coverage according to all service lines
• Ensure staff are well trained in and comply with contractual, accreditation, clinical coverage policy, and all organizational/departmental policies, procedures, and business processes
• Organize workflows and ensure staff understand their roles and responsibilities
• Ensure the department has the needed tools and resources to achieve organizational goals and to support employees and ensure compliance with licensure, regulatory, and accreditation requirements
• Actively establish and promote a positive, diverse, and inclusive working environment that builds trust
• Ensure all staff are treated with respect and dignity
• Ensure standards are transparent and applied consistently, impartially, and ethically over time and across all staff members
• Work to resolve conflicts and disputes, ensuring that all participants are given a voice
• Set goals for performance and deadlines in line with