RN Clinical Assessor (Hybrid - Central Virginia)

CNSI and Kepro are now Acentra Health! 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 company’s mission, actively engage in problem-solving, and take ownership of your work daily. 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 seeks a RN Clinical Assessor (Hybrid – Central Virginia) to join our growing team.

Job Summary:

The RN Clinical Assessor serves a unique dual role as a care coordinator: completion of needs-based assessments of level of care (LOC) to allow targeted individuals to remain in or return to a home and community-based setting. Assessments are generally performed in the beneficiary’s primary residence; and as a pre-authorization nurse: reviews requests for medical treatments, services, or procedures for Medicaid fee-for-service services. Pre-authorization reviews require nurses to assess, evaluate, and provide recommendations to help ensure members receive the services they need.

*Position is hybrid, candidates must reside in the Central region of the State of Virginia and have reliable transportation to travel across the state.

Job Responsibilities: 

• Conducts assessment to determine whether the beneficiary meets the conditions and criteria for CMS wavier eligibility, using state-approved standardized assessment tool(s).
• Establish a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality outcomes.
• Interact and collaborate with multidisciplinary care team, which includes physicians, nurses, case managers, pharmacists, and social workers/educators to ensure beneficiary needs and preferences for health services/information is shared; educates beneficiaries about community resources/options; advocates on behalf of the beneficiary.
• Prepare documentation, status updates, event notifications and other documentation regarding beneficiaries in accordance with regulatory requirements and company policies and procedures.
• Monitor case load to ensure all required documentation and entry of assessment results into web-based database are completed accurately and timely.
• Attend and actively participate in staff meetings and conduct case consultations/peer reviews/internal auditing as assigned.
• Reviews and interprets patient records and compares against criteria to determine medical necessity and appropriateness of care; determines if the medical record documentation supports the need for services.  
• Determines approval or initiates a referral to the physician consultant and processes physician consultant decisions ensuring reason for the denial is described in sufficient detail on correspondence.

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.

Requirements

Required Qualifications/Experience: 

• Registered Nurse (RN) licensed by the state of Virginia
• 1+ years of experience (preferably case management) in the health or medical field, directly related to homecare, long-term care, or personal care is required.
• Minimum of one year UR and/or Prior Authorization or related experience.

• Knowledge of standards of practice related to Medicaid waivers, home, and community-based services (HCBS) programs, EPSDT, medical fragility, and level of care determinations.

• Knowledge of the organization of medical records, medical terminology, and disease process required.
• 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.
• Ability to utilize computer equipment and web-based software to conduct work.

Preferred Qualifications/Experience:

• Minimum of two years’ experience in home care setting preferred.
• Experience with community-based individuals needing personal assi