Requirements:

Bachelor’s degree in social work, human services or related area preferred from an accredited college or university and at least two years’ experience providing working knowledge of Medicaid home and community-based services, and long-term care services

QUALIFICATIONS:

• Experience and proficiency in use of Microsoft office with an emphasis on Microsoft Excel
• Strong interpersonal skills for working with contract vendor, agency and other professional personnel
• Ability to learn and apply Commonwealth procedures and regulations and standard business practices related to the operations of the contract.
• Demonstrated ability for written and oral communication, and program development responsibilities.
• Strong organizational skills with attention to details and a demonstrated ability to work independently under general supervision.
• Public speaking experience is desirable.

MAJOR POSITION DUTIES AND RESPONSIBILITIES:

The incumbent will be assigned to the Enrollment Unit. The Enrollment Unit is tasked with managing functions related to the eligibility and enrollment process for the Fee for Service (FFS) Home and Community Based Service (HCBS) Programs and the Long-Term Services and Supports (LTSS) Managed Care Program, known as Community Health Choices (CHC). The Enrollment Team is tasked with management and oversight of the enrollment services contract. The enrollment services vendor is responsible for facilitating the eligibility and enrollment process for individuals applying for HCBS Programs administered through OLTL, which currently include the Home and Community Based Waiver programs (CHC Waiver and OBRA Waiver) and the Act 150 Program. The enrollment services vendor will be responsible for managing enrollments and plan transfers into OLTL’s managed care programs, nursing facilities, and helping to facilitate nursing home transition coordination to ensure that quality, effective and efficient services are provided to participants in their communities.

As a member of the Enrollment Unit, the incumbent will be primarily responsible for:

• Managing Enrollment and Eligibility related Inquiries received from various sources including but not limited to the Enrollment Services Vendor and the Case Management Unit.
• Coordinating the Enrollment of individuals being tracked by the Case Management Unit, this includes individuals transitioning from the Department of Corrections, State Hospitals, out of state and other transitions identified as complex.
• Review and complete follow up and resolution in regard to eligibility and enrollment related complaints received through the OLTL participant helpline. Calls may be received from, but not limited to, applicants, family members, representatives, advocates, service coordination agencies, Managed Care Organizations (MCOs), and other stakeholders.
• Respond orally and in writing to enrollment and eligibility inquiries received from the Office of Legislative Affairs and other Offices.
• Use established regulations, policies, and procedures to provide guidance and technical assistance to the Independent Enrollment Broker (IEB), service coordinators, MCOs, Nursing Home Transition providers and other stakeholders in regard to the eligibility and enrollment process.
• Review and evaluate applications for HCBS FFS waivers and Act 150 Program. Complete program denial notice and notice of appeal for applicants that do not meet program eligibility requirements.
• Participate in hearings for appeals related to program eligibility determinations and other eligibility and enrollment appeals as required.
• Review and analyze Operational Reports received from the Enrollment Services Vendor and the CHC MCO for monitoring of contract requirements.
• Review and analyze daily, monthly and quarterly reports that identify records with issues/errors that are preventing enrollment into an OLTL LTSS program. Issues/errors include, but are not limited to, records with open facility and waiver codes, ineligible citizenship codes, open enrollment with another program office, inter-county transfers, FFS to CHC transfers etc. The incumbent will confirm the issue and complete follow-up with appropriate agency or program office including the IEB, SC agencies, MCOs, OMAP Bureau of Data and Claims Management, Office of Income Maintenance, the LIFE Program and others appropriate.
• Use specialized databases such as, but not limited to, electronic Client Information System (eCIS), PROMISe, Home and Community Services Information System (HCSIS), Social Administration Management System (SAMS), to ensure enrollments are completed per established regulations, standards and requirements.
• Develop and prepare weekly reports of all tasks and activities.
• Identify any operational issues which impede the provision of appropriate, cost-efficient services to individuals and recommend remedies/necessary changes to supervisor. As a member of a Team or Division group, participate in developing/revising OLTL home and community-based program policies and procedures.
• Participate in developing and presenting training to Division staff, other OLTL staff, key constituents and providers.
• Serve on workgroups, comprised of staff from within OLTL or stakeholders from outside OLTL. Committee work may include evaluating policy recommendations, directives and regulations; and assisting with the development of operational manuals, program directives, work plans, system changes, regulations, policies and procedures in regards to the eligibility and enrollment process.
• Attend and participate in team meetings, division meetings and bureau meetings as scheduled.
• Perform other related duties as required.

About Us:

TulaRay partners with clients to create staffing solutions that meet unique organizational needs. Our services are designed to reduce administrative burdens, protect your brand, and improve assignment time-to-fill. We believe that mutually successful client relationships are built on lasting quality and exceptional customer service. We pride ourselves on our uncompromising commitment to high-quality emergency management & healthcare personnel, while ensuring that our clients are taken care of with personalized attention. TulaRay manages total compliance and respectfully supports hundreds of professionals and patient-centered programs.

TulaRay is proud to be an affirmative action employer and is committed to providing equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. If you have a disability or special need that requires accommodation, please let us know by visiting our website at tularay.com