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Acentra Health

Modernizes public healthcare with claims solutions

RN Clinical Assessor

Medical, Clinical & VeterinaryConfirmed live in the last 24 hours
Full-timeWest Virginia, USA$67.3k - $72k /yrHybrid

About the Job

Requirements

  • Hold a valid, unrestricted Registered Nurse license for West Virginia or a compact license.
  • Have an Associate of Science in Nursing degree from an accredited college or university; a Bachelor of Science in Nursing is preferred.
  • Have a valid West Virginia driver's license and access to reliable transportation.
  • Be willing to travel to homes and facilities within the catchment area, with occasional travel outside the area to cover for others or attend meetings and events.
  • Accurately assess medical conditions, symptoms, and functional abilities.
  • Have computer skills with Microsoft Outlook, Microsoft Word, Microsoft Edge, and Google Chrome.

Responsibilities

  • Educate and perform medical eligibility assessments for West Virginia Medicaid recipients seeking community-based services, following prescribed guidelines for Pre-Admission Screening to determine eligibility for the Personal Care Program and Aged & Disabled Waiver Program.
  • Manage a caseload of assigned members to ensure assessments are scheduled, appropriate people are present, assessments are performed, and data is entered into Atrezzo within prescribed timelines.
  • Document contacts, schedule appointments, and travel to conduct and document Pre-Admission Screening assessments within prescribed timelines.
  • Participate in inter-rater reliability activities to ensure consistent assessment administration and adherence to protocols, and participate in denial hearings as necessary.
  • Contact physicians and facilities to confirm medical information.
  • Use state-approved standardized assessment tools to determine whether beneficiaries meet Personal Care Services eligibility conditions and criteria.
  • Ensure Personal Care Services are provided on a needs basis and in quantities appropriate to beneficiaries' unmet needs, considering the severity of medical conditions, functional disability, and physical or cognitive impairment.
  • Maintain the privacy and dignity of individuals receiving Personal Care Services assessments to the highest standards.
  • Conduct new, expedited, annual, change-of-status, mediation/appeals, reconsideration-review, and derivative assessments within established timeframes.
  • Interview family members and informal caregivers who are present at the assessment.
  • Provide beneficiaries with guidance and assistance, as necessary, to select Personal Care Services providers.
  • Submit completed assessments using the state-approved interface.
  • Participate in beneficiaries' mediation and appeal processes.
  • Attend and actively participate in staff meetings and conduct case consultations, peer reviews, and internal auditing as assigned.
  • Read, understand, and adhere to corporate policies, including policies related to HIPAA and its Privacy and Security Rules.

Desired Qualifications

  • Have two years of experience in a home care setting.
  • Have two years of experience with the aging population or persons with disabilities, preferably working within the West Virginia Personal Care program.
  • Know the policies and procedures of the Personal Care and Aged and Disabled Waiver programs.

About the Company

Acentra Health

Modernizes public healthcare with claims solutions

Acentra Health helps public-sector health programs run better by combining deep knowledge of government health programs with clinical expertise and technology. It designs and delivers software and services for claims, encounter, and provider data to improve processing efficiency and reduce costs, while offering care-management and quality-oversight services that focus on clinically informed decision making. Its products connect providers, payers, and government agencies to streamline workflows and oversight across state and federal programs. The company differentiates itself through its blend of public-sector know-how, clinical focus, and technology, accelerated by the backing of Carlyle, with a goal of delivering measurable outcomes for priority populations. Overall, Acentra Health aims to improve health outcomes, increase program efficiency, and lower costs for government healthcare programs.

Company size
1,001-5,000
Company stage
Not listed
Total funding
Not listed
Headquarters
McLean, VA
Founded
2023

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