Title: MI Health L Link Auditor $25.51 - $38.07 / Posted thru: 6-6-19
Employee Name: TBD
Supervisor: Allison Repp
Purpose: The MI Health Link Audit will assist with conducting audits of Integrated Care Organizations (ICOs) to aid in determining compliance with MI Health Link C-Waiver program requirements.
Duties and Responsibilities:
• Assist with conducting MI Health Link C-waiver audits for ICO’s. • Aid in conducting audit entrance conferences on-site, via WebEx, t telephonically, or a combination of the t three depending on program needs. • Collaborates for desk audits to r review, Electronic Medical Record (EMRs), I Integrated Care Bridge Records (ICBRs), i individual Integrated Care and Supports P Plans (IICSPs), member assessments, care c coordinator professional licensure v verifications, ICO policies and procedures, a and other documentation as appropriate. • Aids to facilitate on-site visits to I Integrated Care Organizations (ICOs). • Supports conducting “Home Visits” to v verify members are receiving the services t they were assessed for and approved to r receive. • Review critical incidents, as needed. • Writing audit reports to document evident and non-evident findings. • Reviews, makes recommendations for, and approves ICO’s Corrective Action Plans ( (CAP). • Monitor ICO’s CAPs. • Collaborates with stakeholders to e enhance audit protocols, develop audit tools f for the auditors as well as the ICOs, and d develop internal and external audit training m materials. • Aids to write, review, revise, and e enhance audit protocols. • Develop objective audit tools that w will be used internally by the auditors to m maintain consistency in all audits. • Develop an objective audit tool(s) t that will be used externally by the ICOs in p preparing for their audits. • Develop audit training materials, i including a PowerPoint presentation, to e educate ICOs on the audit process, tool(s) a and expectations. • Represent the best interest of MDHHS a and MPHI at all times. • 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 with the a above licensing requirements. • 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 (C (CHAMPS, LOCD, WSA) is preferred, but not re required.
Work Environment and Physical Requirements: Standard office environment. Travel will be required for approximately 15% of this position’s work duties. Employee is resp responsible for overnight accommodations up fron front and will be reimbursed upon completion of t of travel reimbursement forms. It is pref preferred that State of Michigan Vehicles are are utilized when available for ICO/home visi visits throughout the State of Michigan.
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.