Waiver Services Specialist

Job Title: Waiver Services Specialist

Job Summary:

The Waiver Services Specialist is responsible for the enrollment, tracking, and maintenance of

Waiver certifications and re-certifications for Waiver enrollees who are supported by Community Living Services. The Specialist must have knowledge of waiver services offered in Michigan such as the Habilitation Supports Waiver (HSW) Program, Children's Waiver, Autism Waiver, 1915(i)Spa and any other Waiver programs that become available. The Specialist provides the coordination and oversight needed to assure Waiver certifications are current, signed, and authorized consistent with the person's Individual Plan of Service (IPOS). They will track and verify individual enrollment status via the state database and assist with completing the recertifications process before expiration of the current certification. This position will serve as our CLS liaison and representative for all Waiver benefit plans.

Reporting Relationship: Supports Coordination Director

Job Responsibilities:

• Work with our funders and our Support Coordinators to identify individuals who may be eligible for the HSW (or other waiver programs) and assist with assembling documentation and gathering qualifying materials to complete the initial application packet.
• Maintain a tracking system to monitor and assure follow up on all Waiver reports, applications, enrollments, recertifications and disenrollments. Utilize and maintain Waiver Smartsheets for tracking and keep current.

• Track HSW certification expiration dates and submit recertification packets to WSA at least 2 months prior to the due date of the recertification (to allow sufficient processing and approval time).

• Prepare and provide the HSW Consent form to Supports Coordinator to sign and obtain person/legal representative’s signature for Initial HSW applications and for HSW recertifications (every 3 years). Review to ensure that HSW Consent has required signatures. Save completed consent to HSW Smartsheet and upload to the person’s Arrow record.
• Review the Arrow record for individuals who are due for recertification (at least 3 months prior to due date) and notify the Supports Coordinator of documentation that is needed to complete the recertification. Complete follow up to obtain documentation to ensure recertifications are submitted to WSA at least 2 months prior to the due date.
• Review HSW recertification and initial application documents and information to assure that all standards are met (the Individual Plan of Service {IPOS} includes the medical necessity criteria including the amount, duration, and scope of services and supports; HSW authorized services, goals, objectives, and interventions are S.M.A.R.T and in accordance with county and state expectations; documentation includes appropriate signatures and the individual’s Medicaid is active, etc.)
• Update Waiver Supports Application (WSA) State database with HSW recertification information and required documentation to include; HSW recertification consents (every 3 years); Major Life Activity (MLA); the Individual Plan of Service document that includes the habilitative Goal, Objective, & Intervention and HSW authorized services that the individual is receiving
• For Initial HSW Application packets, review of all required documents to ensure standards are met and notify DWIHN to open the individual’s record in WSA. Submit HSW Application packet to WSA and monitor status of approval process.
• Utilize reports in WSA to monitor.
• Notify the Supports Coordinator and Supervisor of new approved HSW enrollments. Add the new enrollment information to the HSW Smartsheet and to the insurance policy section in Arrow.
• Utilize reports in WSA weekly to monitor inactive status, new enrollments, disenrollments, certification & consent due dates and complete all necessary follow up. Update insurance policy section in Arrow when an individual is disenrolled from a Waiver program.
• Check the WSA daily for any pended back packets, and promptly follow up to resolve any needs that are identified and resubmit to WSA.
• Utilize the HSW No Service report in WSA monthly to ensure individuals receive at least one Habilitation Supports Waiver (HSW) service per month. Follow up with Supports Coordinators if monthly service provision is not being utilized and provide updates on status to DWIHN.
• Monitor all hospitalizations and rehabilitation admissions/discharges of the individuals for "Inactive" status adjustments. Notify DWIHN for any changes that may impact the person’s enrollment in the Waiver (individual no longer meets one or more of the eligibility criteria, voluntarily withdraws from the Waiver program, no longer utilizing a HSW eligible services, is residing in long term care, person is deceased, etc.)
• Upon receipt of MDHHS HSW Recertification/Initial HSW Certification final approval certificate from DWIHN, upload certificate to the person’s Arrow record and mail a copy of the approval certificate to the individual/legal representative.
• Maintain accurate insurance policy data in Arrow regarding individual’s enrollment in Waiver programs (HSW, 1915(i)Spa, CWP, etc.) Update data to reflect new enrollments & disenrollments.
• Maintain a current report of children/youth enrolled in Children’s Waiver Program (CWP). At least 6 months prior to the date the youth will age off the CWP, prepare and provide the HSW Consent to the Supports Coordinator to obtain signature. Work with the Supports Coordinator to prepare the HSW initial packet. Submit initial application packet to WSA at least 4 months prior to the CWP ‘age off’ date.
• Work in coordination with the assigned Benefits Broker to assure all individuals on various Waivers have Medicaid eligibility. Maintain tracking for individuals with inactive Medicaid or a Medicaid Spenddown. Check Medicaid status weekly and submit initial or recertification when Medicaid is active.
• Coordinate any moves out of county to assure transition of Waiver status properly occurs.
• Receive referrals from individuals supported by CLS, Support Coordinators or guardians needing assistance related to their needs for Waiver Services.
• Communicate with DWIHN on a regular basis with status updates regarding potential enrollments, initial applications and enrollments, recertifications, disenrollments and pend backs. Submit required documentation to DWIHN within identified timeframes
• Attend all trainings and informational/update sessions regarding Habilitation Support Waiver (HSW), 1915(i)Spa, Children's Waiver Program (CWP), MI Choice Waiver, Autism, and any other waivers services as they become available.
• Serve as our Waiver liaison to funders, provider network, stakeholders, and legal representatives in communicating required and pertinent information relative to various Waiver services and requests.
• Provide training and guidance to Support Coordinators and other stakeholders on the benefits of Waiver services, and the requirements and standards for new and continued enrollment.
• Comply with waiver processing protocols established by our funders at the county and state level.
• Ensure the non-duplication of habilitation services by other program providers
• Be our internal subject matter expert on Waiver regulations and the criteria outlined in the Medicaid Provider Manual.
• Provide education and attend meetings with internal and external stakeholders to present new and/or changes in procedures, benefits coordination, and/or related topics.
• Prepare documentation, summaries and other departmental reports as required.
• Participate in agency work groups and special projects. Provide other assistance and supports as requested.
Assist with the preparation and follow up related to all Waiver audits conducted by funders or accrediting agencies.

Qualifications and Requirements:

Education and Experience:

Minimum of a bachelor’s degree in a Human Service field preferred or five years of applicable experience.

Special Knowledge/ Skills:

Ability to communicate effectively and establish positive collaborative relationships. Must be a highly conscientious and organized person, with independent work skills. Excellent computer skills required, including knowledge of and proficiency with word processing, spreadsheets, email and various databased. Experience with PCE systems, such as ARROW and MHWIN preferred. Ability to develop proficiency in the use of state portals and databases. Demonstrated experience with system development and tracking/monitoring systems preferred.

Training:

On the job training provided. Must complete mandatory training requirements on an annual basis.

Travel:

Periodic scheduled and non-scheduled travel required in executing essential duties and responsibilities of this position. Employees must provide their own transportation. Maintenance of a valid driver's license, an acceptable driving record, and vehicle registration and insurance in compliance with State of Michigan requirements are all continuing conditions of employment. If driving a vehicle other than the one listed on file with the Human Resources Department, employee is responsible for ensuring the vehicle is registered, insured, and meets all other State of Michigan motor vehicle requirements and providing documentation as requested.

CLS policy restricts the use of an alternate driver without the express, prior written authorization of the Human Resources Director. A review of such request will be based on evaluation of HIPAA compliance issues, work restrictions and other relevant factors.