POSITION TITLE: Title XIX Medicaid Case Manager – CM 5
REPORTS TO: Program Manager
Case Managers are responsible for the development, implementation, and monitoringof Long TermCare Services to Medicaid recipients, 18 and older. Services are responsive to the needs of the client that enable them to reside in their home setting of choice, while meeting quality assurance measures in accordance to Medicaid and Health Care Authority regulations and policies.Case Managers provide client-centered approachesto support the client’s independence andadministerthe department’s Comprehensive Assessment, Reporting & Evaluation (CARE) assessment that determines functional eligibility.
Include the following. Other duties periodicallyassigned by the ProgramManager, Community
Living Connections (CLC) Division Director, and/or Assistant Director.
* Conduct in-person/remote comprehensive assessments at least annuallyto determine in-home functional eligibility for Long Term Care Services for clients.
* Provide case management services to include; service plan development, care plan implementation, and appropriate service plan termination.
* Authorize services according to that plan and monitor that plan is being appropriately applied and meeting the client’s needs.
* Manage/liaison client-related requests for additional resources or supports.
* Maintain working knowledge of the department regulations and procedures involvingall programs Rural Resources administers.
* Provide client advocacy as well as consultation, program networking, familialsupport, and crisis intervention.
* Remain current on state and federal policy, laws and regulations governing program and services.
* Maintain systems and record keeping for the proper evaluation, control, and documentation of assigned operations.
* Prepare reports and correspondence as required.
KNOWLEDGE, SKILLS AND ABILITIES:
- Knowledge of dynamics of aging and long term care services, case management principles and practices, quality assurance approaches, social service program monitoring and evaluation techniques, simple mathematical functions, data collection techniques, technical report writing, and computer applications in social services.
* Strong boundaries to conduct constructive, supportive approach to effectively triage with the client/care providers/medical professionals/medical equipment contractors/community stakeholders.
* Able to work together as a team to achieve successful outcomes for our shared clients in combination with the ability to work independently making decisions, at times, in immediate safety situations.
* Knowledge of Medicaid terminology/acronyms, regulations, and policies.
* Knowledge of DSHS database systems such as payment systems and service eligibility programs.
* Professional experience working with vulnerable adults assessing risk and determining functional capabilities.
* Strong skills in prioritization, organizational and time management skills.
REQUIRED EDUCATION AND EXPERIENCE:
A Bachelor’s degree in social services, human services, behavioral sciences, criminal law/justice or an allied field and two to three years related experience.
REQUIRED CERTIFICATION AND LICENSES:
- Valid driver’s license in state of residence.
- Auto insurance in the amount required by the State of Washington.
- Access to reliable transportation.
- Acceptable completion of a criminal history background check.
- Obtain tuberculosis (TB) vaccination within two weeks of employment.
PHYSICAL DEMANDS AND WORK ENVIRONMENT
The physical demands described here are representative of those that must be met to successfully perform the essential functions of this job.
- While performing the duties of this job, the employee is regularly required to, stand, sit; talk, hear, and use hands and fingers to operate a computer and telephone, and keyboard reach.
- Specific vision abilities required by this job include close vision requirements due to computer work.
- Light to moderate lifting is required.
- Ability to uphold the stress of traveling.
- Regular, predictable attendance is required.
The work environment characteristics described are what is encountered while performing the essential functions of this job.
- Moderate noise (i.e. business office with computers, phone, and printers, light traffic).
- Ability to work in a confined area.
- Ability to sit at a computer terminal for an extended period.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
* Denotes Essential Functions
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