Case Manager, Initial Assessments

SUMMARY DESCRIPTION: The Case Manager, Initial Assessments is responsible for implementation of the Medicaid Waiver Home and Community-based Services Program within the TARCOG area following specific requirements as set out in Medicaid Waiver guidelines. Examples of duties include assessments of new clients, yearly redeterminations of current clients, home visits to monitor services provided by contractors and determine additional needs of client, verification of monthly billing submitted by contractors, and completion of daily service logs.

SUPERVISORY CONTROLS: Receives general guidance from the Medicaid Waiver Program Manager. The employee is responsible for independent planning and executing assigned tasks. Work is reviewed focusing on overall outcomes and objectives.

RESPONSIBILITIES AND DUTIES:

1. Establishes referral sources by disseminating information to organizations, agencies, and individuals. Receives and responds to verbal and written referrals of eligible Medicaid recipients in order to obtain information on potential Medicaid clients and to provide information to referral sources. Works from the existing referral database and screens referrals for eligibility based on the E&D Waiver eligibility requirements (both medical and financial). As referrals are diminished, will perform outreach in the community in an effort to grow the E&D Waiver Program.

2. Initiates specified weekly assessment with potential clients in person to enroll them in the Medicaid Waiver Program. Thoroughly completes the identified number of monthly applications for submission to Alabama Department of Senior Services & Alabama Medicaid. Explains the benefits and limitations of the Medicaid E&D Program to all prospective clients. Submits completed forms to the appropriate state agency and follows up on status of same in order to fill the number of slots allowed by the Alabama Medicaid Agency in a timely manner. Serves as the point of contact for applicants prior to the approval/denials of their application.

3. Identifies and communicates as early as possible when an applicant’s needs are likely to exceed the services TARCOG’s program can safely provide and makes necessary referrals to other agencies.

4. Communicates with physicians, physician’s offices, DSPs and other personnel to execute all assessments in a timely manner.

5. Authorizes contractors to initiate services after receiving notification of approval from Alabama Medicaid Agency, completing assessment forms and forwarding appropriate copies of assessments, care plans, and service authorization forms to the respective contractors. Visits contractors’ offices and exchanges information with appropriate personnel to ensure that the contractors are operating as outlined in guidelines.

6. Once an assessment is approved, will brief designated Case Manager (who will be assigned by Case Manager Supervisor based on current case load and area served) with the intent of a seamless transition and provision of services that are to be delivered as rapidly as possible.

7. Develops, monitors, and revises clients’ Care Plans in coordination with client/caregiver to fit the needs of the client as well as sensitive to the monthly statewide fiscal target. Conducts monthly visits to clients’ homes and evaluates the services being provided by the Medicaid Waiver Program to ensure the services are appropriate, adequate and of acceptable quality. Prepares case notes of visits and evaluations for documentation to be placed in case files.

8. Checks monthly billings submitted by contractors for services rendered to clients in order to determine that the billing is accurate and the claims are in conformity with the clients’ Care Plans. Monitors the cost effectiveness of Waiver services for each client.

9. Conducts yearly redetermination assessments on clients as outlined in Medicaid Waiver guidelines and completes HCBS forms in order to meet requirements prescribed by the Alabama Medicaid Agency.

10. Places all documents as prescribed by TARCOG and the Alabama Medicaid Agency in appropriate folders in order to maintain a permanent case record for each approved client.

11. Composes and maintains the following reports as necessary: HCBS Program Case Management Activity Record, Case Managers Daily Time Logs, and Respite Hour Logs.

12. Meets weekly with Medicaid Coordinator/Trainer and IA team to update on all current pending applications.

13. Exchanges information with Medicaid Waiver clerical staff through written and verbal communication in order to assign work and follow up on tasks.

14. Performs administrative functions as directed by the Medicaid Waiver Program Manager.

The assignment of duties is not limited by the content of the job description.

KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED:

1. Knowledge of social work programs and processes.

2. Knowledge of community resources and support network available to clientele served.

3. Knowledge of Health Insurance Portability and Accountability Act (HIPAA).

4. Ability to communicate orally and in writing to exchange information with co-workers, clients, service agencies, state agency personnel, etc.

5. Ability to relate to the elderly and their unique problems.

6. Knowledge and ability to write and print legibly.

7. Knowledge and ability to operate office equipment including telephone, copy machine, fax machine, computer, and calculator.

8. Knowledge and ability to do basic arithmetic.

9. Ability to read and interpret guidelines and regulations and apply them to the job.

10. Completion of initial case manager’s training within three (3) months of employment. Completion of service coordination core training within one (1) month after initial training is received.

11. Bachelor of Arts (BA) or Bachelor of Science (BS) degree, preferably in a human service-related field from an accredited college or university; or be a Social Worker with a current, active Alabama license. Completion of a probationary period (6 months) to 1 year of experience working at TARCOG, demonstrating outstanding work performance verified by performance appraisals and Quality Performance Assessments; and a full-time employee.

12. A valid driver’s license and a good driving record.

REQUIREMENTS FOR CASE MANAGER, INITIAL ASSESSMENTS:

1. Good communication- phone and face to face

2. Attend required meetings

3. Drive/Insurable under TARCOG’s auto policy

4. Travel- Generally limited to local area

5. Write legibly

6. Use computer, phone, fax, and copy machine

7. Complete required paperwork and reports

Job Type: Full-time

Pay: $20.71 - $22.78 per hour

Benefits:

• Dental insurance
• Health insurance
• Retirement plan
• Vision insurance

Work Location: On the road