Job Summary:
The purpose of this position is to complete needs-based eligibility determinations for patients who are applying for 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 role requires a valid driver's license and travel to various locations, which may include extended periods of driving (up to approximately 8 hours in a day).
· This role may require lifting up to 50 pounds
Responsibilities:
· Conduct assessments to determine whether the beneficiary meets the conditions and criteria for PCS eligibility, using state-approved standardized assessment tool(s).
· Ensure 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.
· Ensure the privacy and dignity of individuals receiving assessment for PCS is maintained at the highest standards.
· Ensure 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 participants currently participating in a 1915(c) HCBS program, using state-approved standardized assessment tool(s).
· Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.
· Registered Nurse NC.
· Minimum of two years' experience in a home care setting preferred.
