Job Summary
Contractor- Personal Care Assistance (PCA) RN assessor:
This field-based position is responsible for performing in-home assessments for PCA services using established guidelines and tools to ensure appropriate level of care and services are authorized.
Responsibilities:
- Assesses for PCA services in the patient’s homes evaluating clinical need against established guidelines and/or standards to ensure that the services provided are medically appropriate and aligned with benefit structure.
- Meets minimum metric requirement of 5 PCA assessments/day.
- Evaluates the necessity, appropriateness and efficiency of service provided.
- Coordinates and assists in implementation of services to meet the needs of the members.
- Coordinates with patient, family, physician, hospital and other external customers with respect to the appropriateness of care from diagnosis to outcome.
- Coordinates the delivery of high quality, cost-effective care supported by clinical practice guidelines established by the plan addressing the entire continuum of care.
- Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services provided.
- Refers members to MLTSS when appropriate.
- Documents accurately and comprehensively based on the standards of practice and current organization policies.
- Interacts and communicates with multidisciplinary teams either telephonically and/or in person, including legal for Medical Fair Hearing testimony, striving for continuity and efficiency as the member is managed along the continuum of care.
- Understands fiscal accountability and its impact on the utilization of resources, proceeding to self-care outcomes.
- Evaluates care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomes.
- Completes other assigned functions as requested by management.
- Performs duties as assigned by management.
Education/Experience:
- High School Diploma/GED required.
- Bachelor degree preferred or relevant experience in lieu of degree.
- A minimum of two (2) years clinical experience is preferred.
Additional licensing, certifications, registrations:
- Active Unrestricted NJ RN License Required.
Knowledge:
- Proficiency in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint); prefers knowledge in the use of intranet and internet applications.
- Working knowledge of case/care management principles.
- Working knowledge of principles of utilization management.
- Prefers basic knowledge of health care contracts and benefit eligibility requirements.
- Prefers knowledge of hospital structures and payment systems.
Skills and Abilities:
- Analytical
- Compassionate
- Interpersonal & Client Relationship Building Skills
- Sound Decision Making
- Active Listening
- Organization/Planning/Priority Setting
- Problem Solving/Critical Thinking
- Team Player
- Time Management
- Written/Oral Communication Skills (Bi-lingual preferred)
Travel (If Applicable ):
- This is a field-based position, daily travel is required (mileage reimbursement provided).
- Requires a car with valid New Jersey State License and Insurance.
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