Personal Care Assistance (PCA) RN assessor

Job Summary

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 patients homes evaluating clinical need aProductst 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.

• 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.

• Active Unrestricted NJ RN License Required.

• 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.

• 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)

• This is a field-based position, daily travel is required (mileage reimbursement provided).
• Requires a car with valid New Jersey State License and Insurance.