**INTERNAL POSTING ONLY** Medicaid Waiver 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 SARPC area following specific requirements as set out in the 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 client needs, verification of monthly billing submitted by contractors, and completion of daily service logs.

Supervisory controls

Receives general supervision from the Medicaid Waiver Team Lead. Supervisor sets the overall objectives and employee and supervisor, in consultation, develop the deadlines, projects, and work to be done; employee is responsible for planning and carrying out the assignment; and work is reviewed only from an overall standpoint.

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. Conducts and prepares on-site assessments on potential clients in order to enroll them in the Medicaid Waiver Program. 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 SARPC’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 Team Lead based on current caseload 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 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 annual 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. Place all documents as prescribed by SARPC 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 regularly with Case Manager Team Lead 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. 15. Other duties as assigned.