Position supervises five Income Maintenance Caseworkers and one Program Integrity Investigator. Adult Medicaid Long Term Care and Program Integrity experience preferred. NC Fast experience required. Strong computer and organizational skills required.I. Primary Purpose of Organizational Unit:
The primary purpose of the Adult Medicaid Unit is to administer the Adult Medicaid Program for Nash County according to federal, state and county guidelines as well as the Alexander vs. Flaherty Exit Court order. This unit is responsible for taking and processing applications and re-determining eligibility on a day to day basis. The unit must adhere to all guidelines, as well as ensure accuracy of eligibility and continued updating of policy and case records. This unit also investigates Public Assistance and Food and Nutrition Services cases to determine if fraudulent practices have occurred.
II. Primary Purpose of Position:
The primary purpose of this position is to manage, supervise and ensure federally mandated Income Maintenance services are appropriately provided to applicants and recipients who meet program eligibility requirements according to state mandated rules, regulations, policy, procedures and general statues outlined by the state, for the county. In circumstances where error has occurred, involving client fraud, this employee will assist the worker in determining the appropriate course of action required to resolve the case. This position requires participation in organizing, planning and decision making regarding the unit’s personnel for hiring, managing performance issues and disciplinary actions. This supervisor is responsible for backing up the Adult Medicaid PLA Supervisor in their absence. These supervisors work closely together, providing training to staff and monitoring work.
The Income Maintenance Supervisor for Adult Medicaid Long Term Care and Program Integrity is responsible for providing direct supervision of IMC III Long Term Care workers, the Outpost position in conjunction with UNC Nash Hospital and IM Investigator II workers monitoring for fraudulent practices.
III. Work Schedule:
Regular Work hours are 8:00 am to 5:00 pm Monday through Friday, subject to after hours duty as required.IV. Duties and Responsibilities:
1. This position is responsible for supervision and maintenance of participation in the Adult Medicaid Programs, insuring that the programs are understood and administered correctly by caseworkers, evaluating for all programs if not eligible for Long Term Care.
2. This position involves decision making on difficult cases, as well as second party reviews to determine accuracy of benefits to avoid costly errors to the county. Second party
reviews are required on all caseworkers records at random by the Supervisor , Lead Worker, and with the help of Staff Development. If it is a very difficult case or decision, the Supervisor is to discuss the case with the IM Program Administrator and/or the Regional and State Program Representatives.
3. This position is responsible for the development and maintenance of training for the Adult Medicaid/Program Integrity Unit, as well as training of new staff and ensuring that the unit’s caseworkers complete required administrative papers needed by the IM Program Administrator, Deputy Director or Director.
4. This supervisor has the responsibility of interviewing disgruntled applicants/recipients and serve in a problem solving capacity with clients, as well as their staff.
5. The supervisor reviews and discusses with the IMCs any cases in which they suspect fraud may be occurring. If, after reviewing, it is determined that there is legitimate misrepresentation, the case is referred to the Fraud Investigator. Cases referred are those in which the recipient has received benefits erroneously. If a caseworker is scheduled to appear in court in regards to a fraud case and is unable to do so, the supervisor will fill the agency’s responsibility to have representation in court.
6. A minimal amount of time is spent taking and processing applications and reviews. These cases consist of employee’s relatives or specialized cases that require that impartiality and confidentiality be maintained.
V. Operational Responsibilities:
A. Planning:
• Develops and revises goals, work standards, polices, and procedures affecting the unit.
• Schedules office visits, field visits, and conferences with supervisees.
• Aids supervisees in setting priorities and deadlines to meet goals.
• Prepares Unit meeting agendas and individual conference agendas.
• Reviews and interprets manuals, legal mandates, new policies, etc., adjusting programmatic and operational goals, policies, and procedures as needed.
• Monitors productive reports, quality control reports and complaints received from the client and the community.
• Meets with the Representative, Consultant, Representative and Regional Medicaid Representative periodically to review changes in regulations, and polices affecting the Unit.
• Acts as a member of the Management Team assisting in establishing agency goals, policies, procedures, etc. and keeps Unit informed of Management Team decisions relating to the agency and the Unit
• Provides input to Program Administrator, Deputy Director and/or Director regarding need for staff, equipment, training programs, etc.
• Acts as local hearing officer for appealed cases within the agency.
B. Organizing and Directing Work:
• This supervisor is responsible for directing the day to day activities on the IMCs and assigning work. Constant assessments of the workload are conducted and the staff is organized and/or shifted to meet the demands of the work. Assignments are made in an effort to ensure equitable distribution of workloads. The flow of work must be organized to adequately cover workloads for absent IMCs and vacant positions.
o Monitors all time reports and approves all leave for the unit. Coordinate coverage of positions when someone is out.
o Gathers statistical data regarding production and individual job performance. Make recommendations to IM Program Administrator regarding budget and staffing needs. Assess need for equipment and supplies.
o Participate in Single County Audit, REDA Audit and any other reviews and audits pertaining to the Adult Medicaid and PI programs. (pre-auditing selected cases, guiding auditors through NC FAST reviews, preparing responses and corrective actions to findings.)
• Keep controls on class action suits, fraud, appeals etc. Supervisor keeps controls in files for purpose of instruction, referrals, reports which may be required by State Office of Social Services Board. Ongoing monthly reports are kept by worker on Alexander Exit Plan as well as reports on monitoring of the exit plan by regional personnel. All controls, printouts, reports, etc. on Program Integrity and Financial Resource reports are also kept under review by worker.
o Read and stay abreast of Program Integrity Policy and Procedures for Administration of Program.
o Approve all Program Integrity Fraud Referrals.
o Programs, summarize for EPICS/NC FAST system, key/enter and assigned to appropriate investigator(s) for substantiation or unsubstantiation.
o Assign new cases in NC FAST to investigators.
o Monitor EPICS/NC FAST monthly reports for timely processing of cases, collections, delinquencies, and transfer in from other counties for ongoing collections.
o Conduct staff meetings with Program Integrity as needed for program concerns or corrections.
o Proof read and edit monthly Program Integrity Committee summaries presented to Program Integrity supervisor prior to approval of recommendation by appointed committee.
o Meet with Program Monitors and or Auditors Annually for case management reviews.
o Complete Corrective Action Plan(s) for non-compliance case issues due to agency errors following M & E State Audits and Monitoring Annually.
o Submit M & E audits to State auditors for final approval of Corrective Action Make required Corrective Actions corrections as requested and resubmit to State Plan.
o Monitor State Corrective Actions.
o Prepare Monthly Program Integrity collection summaries for all fraud cases utilizing State monthly reports based on cases assigned to investigators.
o Present Program Integrity fraud cases to Program Integrity committee monthly for recommendations and approval(s) for investigators further collections, and or court proceedings contingent upon county plan.
• Monitor work to ensure that medical services are being provided to applicants/recipients in a timely manner. The monitoring process also determines whether the completed work meets acceptable standards. Reviewing case records is crucial because of the varied types of medical coverage and the need to assess all applicants/recipients for whatever coverage they are entitled to receive. Failure to properly evaluate all individuals can result in loss of coverage and create county errors. Review cases for compliance with the FRR and BEER reports.
VI. Personnel Responsibilities:
• Training
o Provides on-the-job training and orientation for new staff and on-going training for all staff in individual and group settings.
o Make arrangements for staff to attend formal training to improve skills when offered.
o Conducts staff meetings at least monthly to review new manual material and agency policy, discussing problems within the Unit, and giving staff an opportunity to share problems, concerns, ideas, etc.
• Counseling and Disciplining Employees
o Provides counseling to staff regarding workload, assisting staff in dealing with their own anger and sadness resulting from work with dysfunctional families,
o Provides counseling and support regarding work performance and work habit issues. If counseling and support do not work, supervisor begins the disciplinary process following written agency policy regarding discipline and grievance.
o Makes recommendations to the Deputy Director regarding promotion, dismissal, reassignment, and salary adjustments of staff.
o Approves leave requests and reports.
• Selection of Employees
o Assists the Program Manager and Deputy Director in preparation of structured interviews, participates in interviews of potential Unit members, and makes recommendations in conjunction with the Program Manager and Deputy Director to the Director based on interviews and reference checks.
o Designs new positions within the Unit and is responsible for preparation of new job descriptions and assisting staff with updating of existing positions when changes occur.
• Performance Review
o Evaluates each supervisee on an on-going basis and prepares an annual evaluation or probationary evaluations as required by personnel policy.
• Designing Positions and Preparing Descriptions
o Participates in agency’s decisions for additional positions as deemed necessary according to mandates and agency goals.
o Prepares and updates job descriptions as necessary to maintain positions.
*OTHER DUTIES
Employee will be expected to work in emergency shelters and or perform related disaster tasks and perform other reasonable tasks requested by the IM Administrator, Deputy Director or Director.
VII. Other Position Characteristics:
A. Accuracy Required in Work:
Accuracy required in all aspects of duties performed. Numerical accuracy is required in work with budget and other statistical. Reports. Accurate interpretation of programs, agency, state, and federal policies, regulations laws, etc. is critical.
B. Consequence of Error:
Income Maintenance programs, for which worker is responsible, change constantly since they are based on client needs and are affected by legislation. Therefore, Supervisor is involved daily with making adjustments as a result of constant changes in programs, policy interpretation and legislation. The change may be minor, or major, and require reorganization of a unit, sometimes several times in a 12 month period. Adjustments may include work reassignments, shifting of caseloads, group and individuals conferences. Failure to take this type action will result in disintegration of work flow and functioning in the Income Maintenance Units. Monitoring deadlines and specified time frames is an integral part of this position. When work is not completed within required time frames, deadlines not met, policy not applied, and program not properly monitored, eligible applicants and recipients do not receive mandated services to which they are entitled. This breakdown will result in local and state hearings by clients, actions brought against the agency by client advocacy groups and legal aid, resulting in deterioration of the agency's integrity and credibility. Financial sanctions are also possible against the county. The county is subject to county charge backs as outlined in the Medicaid Manual(s).
C. Instructions Provided to Employee:
Instructions may be written or oral. The Director, Deputy Director, Program Administrator, as well as regional representatives for various programs may provide instruction. Letters, memorandums, printouts and numerous articles and all materials offer suggestions and instructions.
D. Guides: Regulations, Policies and References Used by Employee:
There are many kinds of guides and resources used by the Supervisor in this position. Public Assistance Manuals, Fraud Manuals, Personnel Manual, County Letters, Memorandums, Reports, Printout and Conferences. New enhancements due to ongoing implementation of (NC FAST) North Carolina Families Accessing Services Through Technology which includes Distance Learning for, The Learning Gateway, FAST Help, Job Aids, The Virtual Trainer, NC FAST List Serve Messages, County Champion calls, and Touch Point Calls. These references are used on a daily basis and are necessary for job performance. This list is not inclusive. In addition, agency regional and state personnel are available to provide assistance when needed.
E. Supervision Received by Employee:
Supervisor must prepare and participate in individual conference with the Program Administrator, who assists in providing supervision for this position. Conferences may be scheduled or unscheduled as needed. If there are specific items to be addressed, an agenda is submitted in advance. Agenda items are usually resolved
through oral discussion; however, written instructions are received according to Program Administrator's discretion and as needed.
F. Variety and Purpose of Personal Contacts:
Worker is in contact on a regular basis with the general public, community organizations, social and professional agencies. Worker also has contact with attorneys, senators, legislators, county official's local board members, etc. The primary purpose of these contacts is to provide or gain information regarding social service programs, rules, regulations, and available services.
G. Physical Effort:
The physical requirements of this position are considered as sedentary work with occasional lifting up to 10 pounds. Work involves sitting most of the time.
H. Work Environment and Conditions:
Work is performed in a private office. The office complies with state recommended standards for management office space. Employee would be subject to potential harmful acts from dissatisfied and or mentally impaired clients when responding to requested staff assistance.
I. Machines, Tools, Instruments, Equipment, and Materials Used:
Employee uses personal computer, copier, scanner, calculator, automobile, telephone, and printer in order to perform duties.
J. Visual Attention: Mental Concentration, and Manipulative Skills:
Close visual acuity is required to perform activities such as preparing and analyzing data, viewing computer monitor and reviewing reports, and correspondence. Intense mental concentration is required in planning, developing and implementing strategies dealing with intense public relations areas, personnel counseling and disciplinary actions. Worker must also be attuned to attitudes and behavior of clients and workers through close observation.
K. Safety for Others:
Decisions are made daily by agency staff that affects the lives of clients. The Income Maintenance Supervisor is responsible for helping ensure that appropriate guidelines are in place and adequate training has been provided to assist staff in making critical decisions in situations that might prove to be harmful. Supervisor keeps abreast of any accident and monitors to ensure that forms are completed and disbursed to proper persons for filing etc. Supervisor also takes corrective actions to avoid future accidents.
L. Dynamics of Work:
This position is required to perform under constant stress and intense mental concentration. Day to day performance includes problem solving. Disciplinary problems of advanced nature are referred to worker along with recommended changes that would require adjustment in agency structure. Supervisor is required to use good judgement in planning, organizing, monitoring, supporting and managing personnel on a day to day basis. Worker must be able to effectively evaluate staff members in terms of attitude and performance in order to assess their potential for professional advancement. In addition, confidentiality must be maintained by worker in this position for the protection of staff and clients.Considerable knowledge of all income maintenance programs, forms, and documents used in determining eligibility. Considerable knowledge of the use of the income maintenance manuals. Considerable knowledge of needs, problems, and attitudes of disadvantaged persons. General knowledge of all agency programs and services. General knowledge of community services and programs which could affect the client/applicant. General knowledge of the budget process. Good mathematical, reasoning, and computational skills. Ability to instruct, organize, direct, and supervise lower level employees. Ability to learn basic supervisory/management skills. Ability to communicate effectively with workers, supervisors, applicants, and community agencies to obtain pertinent data and to interpret rules and regulations. Ability to present information orally and in written form.Minimum Training and Experience Requirements
Three years of experience as a caseworker or investigator in an income maintenance program, preferably with one year of supervisory experience; or an equivalent combination of training and experience.