Community Care Worker III

About the role

Serves as a specialist in the Program Support Unit (PSU) performing moderately complex tasks related to managed care Long Term Services and Supports (LTSS).

Work involves frequent contact with case managers in Community Care Services Eligibility (CCSE), individuals enrolled in or applying for 1915(c) waiver services, service providers, LTSS MCOs, relocation specialists, nursing facility staff, the public, Health and Human Services Commission, Managed Care Compliance and Operations, Health Plan Management, and Medicaid for the Elderly and People with Disabilities (MEPD) staff.

Works under general supervision with moderate latitude for the use of initiative and independent judgment.

Responsibilities

• Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.
• Develop, coordinate, and explain Medicaid 1115 waiver programs to applicants and members.
• Authorize or deny waiver services, by sending approval or denial notices to applicants, members and other key parties.
• Validate eligibility in appropriate systems.
• Register waiver program eligibility in appropriate systems, authorize MCOs to begin approved services.
• Coordinate with MEPD staff for enrollment in a Medicaid 1115 Waiver program.
• Perform interest list activities such as confirming contact information is accurate, mailing enrollment packets, determining which MCO individuals want to enroll with, making follow-up contacts as needed, and ensuring individuals’ wish to be assessed for a Medicaid 1115 Waiver program.
• Interpret policy and coordinate activities related to transitioning individuals from the nursing home to the community, handling the transition of children aging out of MDCP services, and people who transition in and out of a Medicaid 1115 Waiver program.
• As appropriate, contact the appropriate person to assist with resolution of obstacles and document the reason for the delay.
• Handle continuum of care issues related to LTSS for Medicaid 1115 waiver members who have been disenrolled or transferred in or out of managed care service areas and are experiencing a gap in services. This could include coordinating with CCSE and between MCO’s as appropriate.
• Aid Medicaid 1115 Waiver members who have been denied services to file a fair hearing with the state. Track and monitor appeal processes through to the decision.
• Handle duties such as complete reports to monitor program operations, research and resolve errors in enrollment and make referrals to MEPD for members who lose Supplemental Security Income (SSI) eligibility.

Requirements

• High School Diploma or GED required.
• Preferred experience with STAR+PLUS Home and Community Based Services program, Medically Dependent Children Program (MDCP), Long Term Services and Supports (LTSS) and/or experience with Medicaid for the Elderly and People with Disabilities (MEPD) services.
• Preferred experience with various types of computer equipment and software including, Outlook, Word, and Excel.
• Preferred experience with state software such as TIERS and SAS.

Qualifications

Knowledge of Medicaid 1115 waiver programs, policies and procedures.

General knowledge of community and government service delivery systems, case guidelines, regulations and policies, interviewing techniques, mental illness and the emotional components of physical illness, individuals’ needs associated with disabilities, and community welfare resources.

Communicating effectively orally and in writing with all types of people, in all types of situations.

Operating computer equipment and being proficient in the use of Outlook, Excel, Word, as well as the ability to gain a general understanding of various state software programs, e.g., TIERS, SAS and CSIL.

Managing stress in high-profile situations while maintaining a professional demeanor.

Identifying systemic problems and ways to resolve same.

Managing workload effectively to meet goals and objectives of Medicaid 1115 waiver programs and meet timeframes.

Identifying potential problems that would have a negative impact on service delivery and acting proactively to prevent the problem.

Establishing priorities according to relative importance and deadlines, setting goals and managing time efficiently.

Skills and Abilities

• Knowledge of Medicaid 1115 waiver programs, policies and procedures.
• General knowledge of community and government service delivery systems, case guidelines, regulations and policies, interviewing techniques, mental illness and the emotional components of physical illness, individuals’ needs associated with disabilities, and community welfare resources.
• Effective communication skills, both oral and written.
• Proficiency in using computer equipment and software, including Outlook, Word, Excel, and familiarity with state-specific software like TIERS and SAS.
• Ability to handle stressful situations professionally and maintain composure.
• Problem-solving and conflict resolution skills.
• Time management and prioritization skills.

Benefits

Comprehensive benefits package including 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement, and more.

Pay

$2,953.25 - $4,365.66 monthly

Schedule

Day shift