Job Summary:

The ADRC serves elders aged 65 or older, adults aged 18-64 with a disability, and their caregivers. Staff support informed decision making, provide Medicaid eligibility assistance for the Statewide Medicaid Managed Care Long-term Care Program (SMMCLTCP), and provide the following duties and responsibilities through customer service that is streamlined, efficient, and consumer-friendly.

Duties and Responsibilities:

Medicaid Outreach and LTCPE, including:

• Counsel individuals on the Statewide Medicaid Managed Care Long-term Care Program (SMMCLTCP), available services, eligibility requirements, the application process, and additional information sources.
• Provide outreach that is standardized and consistent statewide to ensure public awareness of Medicaid programs and services and how to access them.
• Build relationships with and educate service providers and other professionals to facilitate referrals and increase awareness of Medicaid resources.

Medicaid Eligibility Screening and Waitlist Placement, including:

• Accept referrals from the ADRC Helpline and other sources for screening utilizing the DOEA approved 701S screening instrument.
• Determine the individual’s needs and enroll on the Waitlist (APCL).
• Insure accurate data entry into eCIRTS (Client Information and Registration and Tracking System), SharePoint, and the ReferNet database.
• Inform individuals or individual’s representatives about potential eligibility for the Medicaid programs, including their rights and responsibilities.
• Re-evaluate individuals on the waitlist using the standardized screening instrument as required or as requested due to a significant change.

Enrollment Management System (EMS), including:

• Provide the duties outlined in the most recent DOEA EMS release procedure.
• Contact individuals on the release verbally and in writing.
• Verify an individual’s current Medicaid eligibility status.
• Assist the client to pursue the eligibility process with meeting SMMCLTCP financial and medical eligibility.
• Work with client to obtain the Physician Referral form (3008).
• Coordinate with CARES (Comprehensive Assessment and Review for Long Term Care Services) staff for determination of medical eligibility.
• Track Medicaid applications through the eligibility process.
• Act as a consumer advocate by coordinating with CARES and DCF/ESS staff to resolve in a timely manner any eligibility issues that arise during the Medicaid eligibility determination process.
• Assist clients who have lost Medicaid to regain their active status in SMMCLTCP.

Grievances and Complaints, including:

• Provide assistance to SMMCLTCP enrollees, concerning how to file grievances and complaints with the long-term care plans.
• Provide information concerning Medicaid Fair Hearings.
• Maintain a record of such complaints, in accordance with statewide procedures.

Quality Assurance, including:

• Assist with quality assurance reviews of 701S and long-term care education contacts by ADRC staff.
• Assist with insuring eCIRTS data integrity.
• Assist with tracking and reviews of EMS processing to ensure contractual compliance.

Education:

• Possess a bachelor’s degree from an accredited college or university; or
• Have an Associate of Arts Degree from an accredited college or university and a minimum of one year experience as a caseworker, case manager, intake specialist, or experience in performing human services related work; or
• Have a high school diploma or GED and two years’ experience as a caseworker, case manager, intake specialist, or experience in performing human services related work.

Skills/Qualifications:

• Knowledge of computer applications to perform the functions of the position, including word processing, database, and spreadsheet applications.
• The ability to work independently and with minimal supervision.
• Knowledge of available ADRC administered programs and available Medicaid programs.
• The ability to work with disabled adults, elders, caregivers, stakeholders, and community partners in a knowledgeable, engaged, and compassionate manner.
• The ability to set and track personal performance goals to efficiently manage workload.

Special Requirements: Must pass DOEA L