Remote Utilization Review Rn Jobs in Cary, NC (NOW HIRING)

This position requires travel in the field across Durham and surrounding counties. Mileage expenses are reimbursed.
Schedule: Field-based assessments with remote work
 

This field-based role requires you to travel within your region to conduct assessments, and gives you flexibility to work out of your home office as needed. This role supports the Personal Care Services (PCS) program under the North Carolina Medicaid Linking individuals & Families for Long Term Services and Supports (NC LIFTSS) project. NC LIFTSS was created to streamline access to LTSS programs. It covers a variety of services, including performing option counseling, QA reviews, customer service, and provider training. 

You'll provide vital services to NC Medicaid Beneficiaries with medical conditions, cognitive impairments, or disabilities, ensuring they receive the hands-on assistance they need for daily living activities (ADLs). As a PCS Home Health Registered Nurse, you'll play a crucial role in determining needs-based eligibility for Medicaid-funded personal care services, whether in-home, adult care, or supervised living homes. This role is documentation-intensive to meet the needs of beneficiaries, and to help them thrive.

Requirements:

• Registered Nurse, licensed in the state of North Carolina

• Minimum 2 years of nursing experience

• Computer proficiency in Microsoft Excel, Word and Outlook and the ability to utilize computer equipment and web-based software to conduct work 

Preferred Qualifications:

• Experience with community-based individuals needing personal assistance with ADL and IADL tasks is highly preferred.

• Experience conducting PCS assessments preferred.

• Experience with OASIS tool (or similar) preferred.

• Knowledge of North Carolina Medicaid Clinical Coverage Policy (Clinical Policy) 3L and PCS Program Provider Manual highly desired.

• Knowledge of standards of practice related to Medicaid-funded Personal Care Services, home and community-based services (HCBS) programs, and EPSDT highly desired.

What you’ll do:

• Conduct assessment to determine whether the beneficiary meets eligibility, using state-approved standardized assessment tool(s).

• Ensure 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.

• Ensure that 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.

• Submit the completed assessments using state-approved interface.

• Participate in the Beneficiary’s mediation and appeal processes.

• Respond to state inquiries regarding assessments conducted.

• Develop level of care recommendations based upon clinical evaluations.

• Read, understand, and adhere to all corporate policies, including policies related to HIPPA and its Privacy and Security Rules.

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that contract needs may dictate.

Attention Applicants: Please be advised that proper email communication will only be sent from email addresses ending in @astyra.com. Please ensure you are communicating with approved Astyra recruiters by checking this point when receiving offers and messages from us. It is important to communicate within our guidelines and proper channels to expedite possible interview considerations.
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