Category: MM Curator

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Job details

Salary

$40,000 – $50,000 a year

Job Type

Full-time

Qualifications

• Bachelor’s (Required)
  

Benefits

Pulled from the full job description

Dental insurance

Employee assistance program

Employee discount

Flexible schedule

Flexible spending account

Health insurance

Case Manager- Medicaid Waiver

Status: Salary Exempt- Administrative

SOC Code: 21-1093
Department: Medicaid Waiver
Reports to: Medicaid Waiver Program Supervisor
Analysis Completed: July 2016

Description:

The Medicaid Waiver Case Manager assists individuals in gaining access to appropriate, needed, and desired waiver and other State Plan services, as well as needed medical, social, educational, and other appropriate services. The position serves to provide necessary coordination with direct service providers (DSP) of non-medical, non-waiver services when the services provided by these entities are needed to enable the client to function at the highest attainable level or to benefit from programs for which clients might be eligible. The Case Manager reports to the
Medicaid Waiver Supervisor.

Tasks & Responsibilities:

General Duties:

• Prepares personal work plan to meet departmental objectives and expectations; schedules office and field activities to include data collection, research, and meetings.
  
• Assists Program Supervisor as needed.
  
• Communicates with client, caregivers, service providers, and physicians on a regular basis.
  
• Completes and submits required paperwork in a timely manner. Must meet deadlines.
  
• Responsible for maintaining orderly, confidential files.
  
• Conducts verification of monthly service billing and eligibility.
  
• Attends and participates in monthly staff meetings.
  
• Communicates with Assistant Supervisor and Program Supervisor on a regular basis to ensure caseload work is being met.
  
• Prepares and submits daily activity log.
  

Case Management Duties:

• Maintains a caseload of 35-40 clients each month.
  
• Executes ongoing monitoring of the provision of waiver and non-waiver services including the individual’s Plan of Care.
  
• Conducts intake and screening of clients.
  
• Authorizes initial waiver services and determines continued eligibility.
  
• Determines level of care.
  
• Determines choice of institution or community care.
  
• Develops plan of care based on individual needs.
  
• Coordinates, monitors, changes, re-determines, level of services.
  
• Authorizes termination of services or case transfer/termination.
  
• Makes monthly visit to client to ensure level of care is being upheld. Responsible for other required home visits when needed.
  
• Responsible for in depth record keeping including documenting monthly visits and keeping daily logs.
  
• Maintains regular contact with clients and advocates for their rights within scope of services.
  
• Facilitates crisis intervention.
  
• Provides guidance and support for clients, client’s families, and staff.
  

Competencies:

• Active listening skills.
  
• Ability to communicate in a collaborative, effective manner with others and to maintain good working relationships.
  
• Ability to comprehend basic medical terminology.
  
• Possess knowledge of Medicaid Waiver programs and service providers.
  
• Flexibility. Workload may include working before or after normal business hours.
  
• Communication Proficiency. Both written and oral.
  
• Personal Effectiveness/Credibility.
  
• Strong interpersonal skills.
  
• Project Management.
  
• Critical thinking and deductive reasoning skills.
  
• Ability to maintain high degree of confidentiality.
  
• Microcomputer skills to preform word processing and spreadsheet analysis, use databases and software, use e-mail, and access the internet.
  
• Experience with Microsoft Office programs (Word, PowerPoint, and Excel).
  
• Ability to interpret and communicate complex rules and regulations.
  
• Excellent organization skills.
  
• Ability to work towards objectives with little supervision.
  
• Strong time management skills. Ability to meet deadlines.
  
• Problem solving skills.
  
• Attention to detail.
  

Experience:

Bachelor’s Degree from an accredited college or university in human services related field (preferably in social work). At least 2 years of professional experience in the human services field preferred. Knowledge of Medicaid programs and experience working with elderly and disabled people preferred.
-OR-
Master’s Degree in Social Work.
Licensed Clinical Social Worker (LCSW) preferred.

Managerial/ Supervisory Requirements:

None.

Physical Requirements:

May spend long hours sitting and using office equipment and computers. Some lifting of supplies and materials. Work in the field is required. Ability to operate vehicle.

Must pass background and sex offender check.

*The above statements are intended to describe the general nature and level of the work being performed by people assigned to this work. This is not an exhaustive list of all duties and responsibilities. RPCGB leadership reserves the right to amend and change responsibilities to meet business and organizational needs as necessary.

Job Type: Full-time

Pay: $40,000.00 – $50,000.00 per year

Benefits:

• Dental insurance
  
• Employee assistance program
  
• Employee discount
  
• Flexible schedule
  
• Flexible spending account
  
• Health insurance
  
• Life insurance
  
• Paid time off
  
• Professional development assistance
  
• Retirement plan
  
• Tuition reimbursement
  
• Vision insurance
  

Schedule:

• Day shift
  
• Monday to Friday
  

Ability to commute/relocate:

• Birmingham, AL 35203: Reliably commute or planning to relocate before starting work (Required)
  

Education:

• Bachelor’s (Required)
  

Work Location: Hybrid remote in Birmingham, AL 35203

Clipped from: https://careers.amerihealthcaritas.com/us/en/job/27445/Compliance-Regulatory-Analyst?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Responsibilities:

The primary purpose of the job is to:;

• Assist with the implementation of the Compliance program for AH Louisiana.
  
• Assist with the HIPAA desk audits.
  
• Assist with compliance monitoring and auditing activities to ensure contract compliance.
  
• Assist with training staff on Compliance and HIPAA.
  
• Generate compliance and privacy activity reporting.
  
• Assist with State complaints and maintain a log for all complaints.
  
• Maintain all AH Louisiana policies and subcontractor policies that reflect AH Louisiana.
  
• Distribute State e-mails to appropriate staff.
  
• Review Medicaid policies and contract changes to determine impact to the plan.
  
• Maintain contract compliance log of Medicaid policy and contract changes and distribute to appropriate staff.
  
• Assist with member materials and marketing approvals.
  
• Assist with State Compliance Audits.
  
• Act as the administrator for all State applications.;
  

Education/ Experience:

• Bachelor’s Degree or equivalent educaiotn and experience required.
  
• Familiarity with Government Programs and contracts required.
  
• ;2 or;more;years experience;in healthcare/ insurance, preferably in managed care.;;;;
  
• Experience with Microsoft Office Suite.; ;;;;;;;;;;;;;;;
  

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Position Description:
Mathematica applies expertise at the intersection of data, methods, policy, and practice to improve well-being around the world. We collaborate closely with public- and private-sector partners to translate big questions into deep insights that improve programs, refine strategies, and enhance understanding using data science and analytics. Our work yields actionable information to guide decisions in wide-ranging policy areas, from health, education, early childhood, and family support to nutrition, employment, disability, and international development. Mathematica offers our employees competitive salaries, and a comprehensive benefits package, as well as the advantages of being 100 percent employee owned. As an employee stock owner, you will experience financial benefits of ESOP holdings that have increased in tandem with the company’s growth and financial strength. You will also be part of an independent, employee-owned firm that is able to define and further our mission, enhance our quality and accountability, and steadily grow our financial strength.Read more about our benefits here: https://www.mathematica.org/career-opportunities/benefits-at-a-glance.

We are currently seeking a Director of Federal Medicaid Practice to lead the management group within the Learning & Technical Assistance Community. The Director will exercise leadership through a group of supervisors and manages to performance targets for a portfolio of Medicaid program design and operations projects.

Responsibilities:
Work with the Vice President to manage the performance of the Learning & TA Community within the Federal Medicaid Practice by tracking revenue, backlog, billability, open project-staffing requests, and other metrics
Proactively engage unit and project leadership to anticipate and address project and proposal staffing needs
Work with the Vice President and Health Unit leadership to support strategic planning and execution
Serve as a senior resource for supervisors and project directors with staff challenges
Actively work to build and maintain the morale of the staff
Oversee recruitment activity by engaging area directors and the Vice President in staff pipeline assessments and target-setting, and by directing recruitment teams in their hiring efforts
Partner with HR and the Vice President to plan staff development and training activities to ensure the Learning & TA Community is adequately prepared to respond to new opportunities
Partner with HR to support the development of policies and processes for staff assessment and advancement, including the ongoing build-out of the CCF career pathways relevant to staff working in the Learning & TA Community
Maintain relationships with staff in the client space and advise others on client needs, preferences, and priorities
Work with the Vice President and other Federal Medicaid management to support the consistent communication of management policies, priorities, and updates to supervisors and staff
Where needed, work with Federal Medicaid management other Health Unit management to support staff management and the execution of initiatives across communities, departments, and divisions within the Health Unit
Actively support the advancement of organizational diversity, equity and inclusion efforts, and apply a diversity, equity and inclusion lens across job responsibilities
Maintain project participation (50% of the role) on federal Medicaid TA projects

Position Requirements:
A master’s or doctorate degree in public policy, public health, economics, health services research, business administration, management, or other relevant discipline, or commensurate professional experience that may substitute for educational requirements
10 or more years of professional experience relevant to Medicaid policy and health care contracting
5 or more years managing or directing the work of a group of staff (for example, leading strategic initiatives or process improvement activities, reconciling staffing, managing recruitment targets, managing staff development, and directing projects.)
Experience leading and understanding the roles of staff with a wide range of skills relevant to Medicaid technical assistance work, including policy option development, qualitative and quantitative research, data management, data validation, statistical analysis, measurement, stakeholder facilitation, program design and monitoring, feedback reporting, and project management
Ability to gain trust and support from groups of senior staff using both formal and informal leadership structures

To apply, please submit your resume and a cover letter. Applications will be accepted through Monday, February 13, 2023.

This position offers an anticipated base salary range of $120,000 – $185,000 annually.

Various federal agencies with whom we contract require that staff successfully undergo a background investigation or security clearance as a condition of working on the project. If you are assigned to such a project, you will be required to obtain the requisite security clearance.

Available locations: Washington, DC; Princeton, NJ; Cambridge, MA; Woodlawn, MD; Chicago, IL; Ann Arbor, MI; Oakland, CA; Seattle, WA; Remote

To apply, please provide a cover letter, resume, and writing sample.

In accordance with Executive Order 14042 and its implementing guidelines, all Mathematica employees must provide documentation that they have been fully vaccinated or obtain an accommodation through Human Resources by providing documentation from a licensed health care provider that they are unable to be vaccinated against COVID-19 because of a disability (which would include medical conditions) or provide an attestation that they are entitled to an accommodation because of a sincerely held religious belief, practice, or observance.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

Clipped from: https://pruitthealth.jobs.net/jobs/J3V3DL68J762BR8GVGZ?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

PruittHealth is a COVID-19 vaccine-mandated employer.

JOB PURPOSE:
 

Assists the Elderly and Disabled Waiver Program (EDWP) clients who do not
 have active Medicaid eligibility [Potential Medicaid Assistance Only (PMAO) or Medicaid Assistance Only (MAO)], with the Medicaid Application process and follows up with the Division of Family and Children Services (DFCS) to ensure the clients’ eligibility process is complete.

KEY RESPONSIBILITIES:
 

1.   Assists with EDWP Intake. Monitors PMAO and MAO referrals and census data.

2.   Coordinates with Home First Case Management agencies in determining EDWP clients’ MAO or PMAO eligibility or continued eligibility status

3.   Assists EDWP clients with the Medicaid Application process and renewals

4.   Collects copies of financial documents from EDWP clients and submits to DFCS

5.   Completes and uploads necessary provider forms to Georgia Gateway

6.   Follow-up with DFCS routinely using the Medicaid Provider Status Request spreadsheet

7.   Document follow-up with EDWP clients and DFCS via the DCH/DDS electronic data system

8.   Verify Medicaid eligibility or continued eligibility via the Georgia Medicaid Management
 Information Systems (MMIS)

9.   Maintains Medicaid documentation in accordance with EDWP operating procedures and policies as well as auditing entities for Medicaid.

KNOWLEDGE, SKILLS, ABILITIES:
 

•    Knowledge of Georgia Medicaid
  
•    Proficient in using Microsoft Office (Outlook, Word, Excel)
   
  
•    Excellent verbal communication skills, and basic typing ability
  
  
  

Job Requirements:

MINIMUM EDUCATION REQUIRED:
 

Bachelor’s degree in a related field from an accredited college or university OR Associate’s degree from an accredited college or university AND One year of related experience OR High school diploma or GED AND Three years of related experience

MINIMUM EXPERIENCE REQUIRED:
 

One (1) year experience in Medicaid billing, collections, or recovery OR One (1) year experience in the Division of Family and Children Services (DFCS) MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:   N/A

ADDITIONAL QUALIFICATIONS: (Preferred qualifications)

•    B.S. degree in Social Work or in a related field
  
•    Prior experience in the Division of Family and Children Services (DFCS) in the Aged, Blind, and Disabled (ABD) unit
  
•    Two (2) years’ experience in Medicaid billing, collections, or recovery
  
•    Demonstrated knowledge of electronic data systems
  

Proof of COVID-19 vaccination or approved exemption is required by date of hire

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