PCS Assessor, RN

Vaya Health

. Complete needs-based assessments and eligibility determinations for Medicaid beneficiaries applying for State Plan Personal Care Services .

Posted 10/10/2026full-timeRemote • North Carolina • United StatesJuniorMid-Level💰 $68,033 - $88,443 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in conducting needs-based assessments and eligibility determinations for Medicaid beneficiaries, with a strong understanding of North Carolina Medicaid policies and personal care services. Proficient in collaborating with healthcare professionals and providing education to members regarding personal care service options.

Highest-signal resume keywords

Registered Nurse (RN) LicensureMedicaid PCS AssessmentsCommunity-Based Care ExperienceKnowledge of North Carolina Medicaid PoliciesComputer Proficiency in Microsoft Office

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Needs-Based AssessmentsEligibility DeterminationsStandardized AssessmentsLevel-of-Care RecommendationsService Authorization RequestsClinical EvaluationsPerson-Centered ThinkingADL and IADL Task AssistanceMediation and Appeal ProcessesInternal Auditing

Soft Skills

Effective CommunicationIndependent WorkCollaborationEducation and TrainingTime Management

Tools & Technologies

Microsoft ExcelMicrosoft WordMicrosoft OutlookWeb-Based Software

Certifications & Qualifications

Bachelor’s Degree in NursingActive RN Licensure in North Carolina

Industry Keywords

MedicaidPersonal Care ServicesHome Care SettingHCBS ProgramsEPSDTPublic Sector ServicesClinical Coverage Policy 3L

About the role

Key responsibilities & impact

Complete needs-based assessments and eligibility determinations for Medicaid beneficiaries applying for State Plan Personal Care Services
Schedule telephonic and face-to-face assessments with members, families, caregivers, and healthcare professionals
Conduct standardized PCS eligibility assessments in beneficiaries’ homes and communities
Conduct interviews with family members and informal caregivers
Complete assessments within established timeframes
Perform expedited assessments by telephone as needed
Educate and assist members in selecting PCS providers
Collaborate with prescribers and healthcare professionals to ensure requests are accurate and complete
Submit service authorization requests on behalf of PCS providers
Maintain the privacy and dignity of individuals receiving PCS assessments
Participate in mediation and appeal processes
Respond to state inquiries regarding completed assessments
Attend staff meetings and conduct case consultations, peer reviews, and internal auditing as assigned
Develop level-of-care recommendations based on clinical evaluations
Participate in training PCS stakeholders as needed

Requirements

What you’ll need

Bachelor’s degree in Nursing or other healthcare field required
Two years of experience in a home care setting
Active licensure in North Carolina as a Registered Nurse (RN) required
Experience with community-based individuals needing personal assistance with ADL and IADL tasks highly preferred
Experience conducting PCS assessments highly preferred
Knowledge of North Carolina Medicaid Clinical Coverage Policy 3L and PCS Program Provider Manual
Knowledge of standards of practice related to Medicaid-funded State Plan Personal Care Services, HCBS programs, and EPSDT
Knowledge and understanding of public sector services and supports
Computer proficiency in Microsoft Excel, Word, and Outlook
Ability to use computer equipment and web-based software
Ability to communicate effectively through spoken, written, and electronic media
Ability to work independently without a high degree of supervision
Ability to use person-centered thinking and planning, with competency in awareness of the needs of persons with disabilities
Must reside in North Carolina or within 40 miles of the North Carolina border
Ability to travel as needed to Alamance, Chatham, and Caswell counties

Benefits

Comp & perks

Exempt position; not eligible for overtime compensation
Equal opportunity employer