Job Description

Company Overview:

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Job Summary and Responsibilities:

Acentra Health is looking for a Regional Quality Assurance Mentor Reviewer (RN) to join our growing team.

Job Summary:

The Regional Mentor travels to perform education and initial/re-evaluation assessments of Aged and Disabled Waiver members for the purposes of determining program medical eligibility. Provides education to applicants/members and conducts the Pre-Admission Screening assessment. Manages a caseload of assigned members to ensure that assessments are scheduled, appropriate persons are in attendance, assessments are performed and data is entered into the APS CareConnection© within prescribed timelines.

Responsibilities:

• Travel to homes and facilities within the catchment area
• Must be able to accurately assess medical conditions and symptoms and functional abilities
• Conducts mediations at the request of beneficiaries who have had an adverse decision for all programs.
• Works to negotiate settlements during mediations
• Is knowledgeable of NC Medicaid Recipient Due Process Rights and Prior Approval Policies and Procedures in order maintain appropriate systems for implementation and compliance.
• Researches cases in appeal to prepare for mediation to include PCG records as well as independent assessment(s), supporting docs and comm log notes within QiReport.
• Communicates with Mediations Centers to schedule mediations within timelines.
• Enters appeal results into QiReport as applicable.
• Enters Results of Mediation assessment requests into QiReport as applicable.
• Proactively anticipates and works to mitigate problems that could result in customer dissatisfaction or failure to deliver contracted services.
• Performs other duties as assigned by management
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education and experience related duties that management may deem necessary from time to time. 

Qualifications:

Required Qualifications

• Active and current driver’s license required
• Active unrestricted RN State and/or Compact State clinical license.
• Associate’s Degree

Preferred Qualifications

• 2+ years’ experience with aging population or with persons with disabilities
• BSN preferred
• CCM preferred

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations will be made as required by law in an attempt to enable an individual with a disability to perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time; key and/or control objects; interact extensively with internal and external customers; occasionally lift and/or move objects weighing up to 10 pounds; and occasionally travel within the state.

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Thank You!

We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!

~ The Acentra Health Talent Acquisition Team

Visit us at Careers - Acentra Health  

EEO AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

Compensation

The pay for this position is listed below. 

“Based on our compensation philosophy, an applicant’s position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.”

Pay Range: USD $53,840.00 - USD $82,000.00 /Yr.

Job Tags

Full time, Local area,

Similar Jobs