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

<p> <p>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.</p> <p><strong>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.</strong></p> <p><strong>Responsibilities &amp; Duties</strong></p> <p>PCS Assessment and Collaboration</p> <ul><li>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</li> <li>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</li> <li>Cross covers and reviews the PCS Assessor-RN to submission of service authorization requests (SARs) on behalf of PCS provider</li> <li>Reviews PCS Assessments for clinical accuracy in line with Clinical Coverage Policies and Contractual Requirements\</li> <li>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</li> <li>Reviews PCS Service Plans for completeness and alignment with member needs identified in the PCS Assessment</li> <li>Holds PCS Assessor-RN accountable to conduct assessments and develop Service Plans  within established timeframes</li> <li>To accommodate expedited requests, performs PCS assessments  virtually, consideration for telephonic based on member availability and timelines</li> <li>Provides education and assistance to the member, as necessary, to select PCS providers</li> <li>Works with prescribers and/or other healthcare professionals to ensure that requests are accurate and complete</li> <li>Ensures that the privacy and dignity of individuals receiving assessment for PCS is maintained at the highest standards</li> <li>In collaboration with Alliance Appeals &amp; Grievances, participates in mediation and appeal processes, as needed</li> <li>Responds to state inquiries regarding assessments conducted</li> <li>Accountable to ensure members referred for PCS assessment are engaged with a primary care manager for ongoing support</li> <li>In collaboration with the manager and provider network, supports collaboration with PCS services providers and identifying gaps in provider network adequacy</li> <li>Works collaboratively with Utilization Management to ensure timelines and member needs are met </li> <li>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</li> </ul> <p>Administrative Functions</p> <ul><li>Monitors referrals and timely coordinates assignment to PCS Assessor-RN </li> <li>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</li> <li>Attend and actively participate in staff meetings and conduct case consultations/peer reviews/internal auditing as assigned</li> </ul> <p>Manage and Develop Staff</p> <ul><li>Work with Human Resources, Director, and Managers to maintain and retain a highly qualified and well-trained workforce</li> <li>Develop and maintain the schedule of staff to ensure adequate coverage according to all service lines</li> <li>Ensure staff are well trained in and comply with contractual, accreditation, clinical coverage policy, and all organizational/departmental policies, procedures, and business processes</li> <li>Organize workflows and ensure staff understand their roles and responsibilities</li> <li>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</li> <li>Actively establish and promote a positive, diverse, and inclusive working environment that builds trust</li> <li>Ensure all staff are treated with respect and dignity</li> <li>Ensure standards are transparent and applied consistently, impartially, and ethically over time and across all staff members</li> <li>Work to resolve conflicts and disputes, ensuring that all participants are given a voice</li> <li>Set goals for performance and deadlines in line with organization goals and vision</li> <li>Effectively communicate feedback and provide ongoing coaching and mentoring to staff and support a learning environment to advance team skills and professional development</li> <li>Cultivate and encourage efforts to expand cross-team collaboration and partnership</li> </ul> <p>Travel </p> <ul><li>Travel between Alliance offices, attending meetings on behalf of Alliance, participating in Alliance sponsored events, etc. may be required</li> <li>Travel to meet with members, providers, stakeholders, attend court hearings etc. is required</li> </ul> <p><strong>Minimum Requirements</strong></p> <p>Education &amp; Experience</p> <p><span style="text-decoration:underline;">Required</span>:</p> <p>Graduation from an accredited school of nursing and five (5) years of experience in home care setting.</p> <p>Or</p> <p>Bachelor’s degree in nursing or other healthcare field required and three (3) years of experience in home care setting.  </p> <p>Must have active licensure in North Carolina as a Registered Nurse (RN).</p> <p><span style="text-decoration:underline;">Preferred</span>:</p> <p>Experience with community-based individuals needing personal assistance with ADL and IADL tasks is highly preferred.  </p> <p>Experience conducting PCS assessments highly preferred.</p> <p>Experience with complex behavioral, cognitive, and physical health needs strongly preferred.</p> <p>At least one year leadership experience preferred.</p> <p><strong>Knowledge, Skills, &amp; Abilities</strong></p> <ul><li>Knowledge of North Carolina Medicaid Clinical Coverage Policy (Clinical Policy) 3L and PCS Program Provider Manual.</li> <li>Knowledge of standards of practice related to Medicaid-funded State Plan Personal Care Services, home and community-based services (HCBS) programs, and Early and Periodic Screening, Diagnostic and Treatment (EPSDT).</li> <li>Knowledge and understanding of public sector services and supports.</li> <li>Computer proficiency in Microsoft Excel, Word and Outlook.</li> <li>Ability to utilize computer equipment and web-based software to conduct work.</li> <li>Ability to interact with various office staff as needed to support necessary workflows.</li> <li>Ability to interact with healthcare professionals, patients, their families and other supports.</li> <li>Ability to communicate effectively to individuals and groups through spoken, written and electronic media.</li> <li>Ability to attend to detail, effectively prioritize and execute tasks in a timely manner.</li> <li>Ability to work independently without a high degree of supervision.</li> <li>Develops level of care recommendations based upon clinical evaluations.</li> <li>Participates in training of PCS stakeholders as needed.</li> <li>Ability to use person-centered thinking, planning, and have competency in awareness of the needs of persons with disabilities.</li> </ul> <p><strong>Salary Range </strong></p> <p>$75,600 to $96,390/Annually </p> <p>Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity.<span> </span><span> </span></p> <p><em> </em><em>An excellent fringe benefit package accompanies the salary, which includes:<span> </span></em><em> </em><span> </span><span> </span></p> <ul><li><em>Medical, Dental, Vision, Life, Long Term Disability</em></li> <li><em>Generous retirement savings plan</em></li> <li><em>Flexible work schedules including hybrid/remote options</em></li> <li><em>Paid time off including vacation, sick leave, holiday, management leave</em></li> <li><em>Dress flexibility</em></li> </ul> <h4>Education</h4> Required <ul><li>Associates or better in Nursing</li> <li>Bachelors or better in Nursing</li> </ul> <h4>Licenses &amp; Certifications</h4> Required <ul><li>Driver License</li> <li>Registered Nurse</li> </ul> See job description <img src="https://ars2.equest.com/? response_id=08b0b96c2b2cd08c86b651ccf4edb481&view" alt=" " width="1" height="1"/>