Title: MI Health L Link Auditor $25.51 - $38.07 / Posted thru: 2-24-19
Employee Name: TBD
Supervisor: Allison Repp
Purpose: This position will be responsible for conducting audits of Integrated Care Organizations (ICOs) to determine compliance with MI Health Link C-Waiver program req requirements. This position will also be res responsible for writing audit reports, rev reviewing ICOs corrective action plans (CA (CAPs), and monitoring ICOs CAPs. This pos position will work with other MI Health Link Aud Auditors to enhance audit protocols and dev develop audit tools for both the auditors and and ICOs. This position will assist with the the development of training materials rel related to the audit for use internally, as wel well as externally. The MI Health Link Aud Auditor will participate in Contract Man Management Team (CMT) meetings as app appropriate and review critical incidents whe when necessary.
Duties and Responsibilities: • Conduct MI Health Link C-waiver a audits 1. Conducting audit entrance conferences on-site, via WebEx, te telephonically, or a combination of the three 2. Desk audits to review, Electronic M Medical Records (EMRs), Integrated Care B Bridge Records (ICBRs), Individual I Integrated Care and Supports Plans (IICSPs), m member assessments, care coordinator p professional licensure verifications, ICOs p policies and procedures, and other d documentation as appropriate 3. On-site visits to Integrated Care O Organizations (ICOs) 4. Conducting “Home Visits” to verify me members are receiving the services they were as assessed for and approved to receive 5. Review critical incidents, as needed 6. Writing audit reports to document evident and non-evident findings 7. Review and approve ICOs Corrective Ac Action Plans (CAPs) 8. Monitor ICOs CAPs • Work with other MI Health Link Audit Auditors to enhance audit protocols, develop audit audit tools for the auditors as well as the ICOs, ICOs, and develop internal and external audit audit training materials 1. Write, review, revise, and enhance audi audit protocols 2. Develop objective audit tools that wil will be used internally by the auditors to mai maintain consistency in all audits 3. Develop an objective audit tool(s) th that will be used externally by the ICOs in pr preparing for their audits 4. Develop audit training materials, i including a PowerPoint presentation(s), to e educate ICOs on the audit process, tool(s) a and expectations • All other duties as assigned
Education: Holds current Michigan license as a Registered Nurse (RN), Licensed Nurse Practitioner, Licensed Physician’s Assistant, Licensed Bachelor’s Prepared Social Worker, Limited Licensed Master’s Prepared Social Worker or Licensed Master’s Prepared Social Worker, Limited Licensed Bachelor’s Prepared Social Worker
Experience: A minimum of one year of exp experience working with elderly individuals and and/or adults with disabilities. Experience in in auditing and/or regulatory experience pre preferred.
Important Skills and Characteristics: • Up-to-date clinical skills • Experience with the elderly p population or adults with disabilities • A basic understanding of healthcare c critical incidents • A basic understanding of Medicare a and Medicaid • Critical thinking skills • Competence in using Microsoft Office i including Word, Excel, and Power Point • Experience with state data systems (CH (CHAMPS, LOCD, WSA) is preferred, but not req required
Work Environment and Physical Requirements: • Use of personal vehicle required for ICO/home visits throughout the State of Michigan. Employee is responsible for overnight accommodations up front and will be reimbursed upon completion of travel reimbursement forms. Travel will be required for approximately 15% of this position’s w work duties. • Job may require moderate physical e effort including lifting materials and e equipment of approximately 50 pounds or less • Job involves viewing a CRT or VDT s screen 25% to 75% of the time • Standard office environment
RESPONSIBILITY FOR THE WORK OF OTHERS: No as assigned responsibilities.
IMPACT ON PROJECTS, SERVICES AND OPERATIONS: MI Health Link is a demonstration program in the Integrated Care Division of the Michigan Department of Health and Human Services. The MI Health Link C-waiver offers services that are not included in the Michigan Medicaid State Plan Benefit package to individuals who qualify. These services allow enrollees who meet nursing facility level of care to live independently in the community as opposed to institutionalization. An Integrated Care Organization (ICO) must submit an application for review and approval by the state before they can deliver C-waiver services to their members. MI Health Link has 5,000 waiver slots available for individuals to receive C-Waiver services.
The MI Health Link program is required to audit ICOs annually to assure recipients of C-Waiver services are receiving services in line with the approved MI Health Link 1915 (C) HCBS C-Waiver, three-way contract, and HCBS Final Rule. MDHHS is required to complete reports for CMS on the status of the MI Health Link C-Waiver Audits based on t the audit activities that ensued each year.