Title: Department Specialist - MI Health Link Waiver and LOCD R Reviewer $25.51 - $38.07 / Posted thru: 6-6-19
Employee Name: TBD
Supervisor: Allison Repp
Purpose: Review applications and recertification packets for individuals requesting services through the MI Health Link Home and Community Based (HCBS) C-waiver to determine service needs. Assist in program integrity processes for Level of Care Determinations (LOCDs) as appropriate. Provide support to the program audit team for tasks related to the Integrated Care Organization’s C-waiver audits.
Duties and Responsibilities:
• Review applications and recertification packets for individuals requesting services through the MI Health Link Home and Community Based (HCBS) C-waiver to determine service needs. • Reviewing C-waiver application for completeness including requirements of the 3-way contract, HCBS Final Rule, and program M Minimum Operating Standards (MOS). • Assuring an LOCD has been completed f for the timeframe being requested in the w waiver application packet. • Reviewing the enrollee’s care plan for c-waiver services, as well as other r required documentation, to determine f functional need. • Complete approval or denial c correspondence for the waiver as appropriate. • Assist in program integrity p processes for Level of Care Determinations ( (LOCDs) as appropriate. • As determined by the LOCD design t team, assist the MI Health Link Team in o operationalizing and completing program i integrity processes for LOCD reviews. • Provide support to the program audit team for tasks related to the Integrated Care Organization’s C-waiver audits. • Review clinical records for a appropriate documentation. • Conduct home visits for quality a assurance and write reports as appropriate. • Verify professional credentials of l licensed Health Plan staff. • Facilitate oversight and monitoring o of ICO Corrective Action Plans. • Assist in reviewing potential c critical incident documentation submitted to M MDHHS from contracted health plans, as a appropriate. • Review potential critical incidents s submitted to MDHHS by contracted Integrated C Care Organization (ICO) for appropriate f follow up and remediation. • Assist in developing training m materials and conducting training o opportunities for contracted Integrated Care O Organizations (ICOs) for waiver, audit, L LOCD, and critical incidents as needed. • Represent the best interest of MDHHS a and MPHI at all times. • All other duties as assigned by mana management.
Education: Holds current Michigan license as a Registered Nurse (RN), Licensed Nurse Practitioner (LNP), Licensed Physician’s Assistant (PA), Licensed Bachelor’s Prepared Social Worker (BSW), Limited Licensed Master’s Prepared Social Worker (LLMSW) or Licensed Master’s Prepared Social Worker (LMSW), Limited Licensed Bachelor’s Prepared Socia Social Worker (LLBSW), or Licensed Practical Nurse Nurse (LPN).
Experience: A minimum of one year of exp experience with the elderly, home care and and/or regulatory experience preferred.
Important Skills and Characteristics: • Up-to-date clinical skills with l licensing as required above. • 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 PowerPoint. • Experience with state data systems (C (CHAMPS, LOCD, WSA) is preferred, but not re required.
Work Environment and Physical Requirements: Standard office environment. Occasional ICO/home visits throughout the state of Michigan. This position may require travel accounting for up to 5% of the employee’s time, specifically for enrollee home visits and hosting training for contracted health plans. If off-site work is required, it is pref preferred that State of Michigan Vehicles are are utilized when available. All other trav travel expenses will be reimbursed upon corr correct completion of travel reimbursement form forms.
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. C-waiver services are services that are not included in the Medicaid State Plan Benefit package. The Integrated Care Organization (ICO) must submit an application for approval before the C-waiver se services are approved by the State. MI He Health Link has 5,000 waiver slots av available. Each application must be reviewed fo for the appropriate need and documentation. Th These services allow enrollees who meet nu nursing facility level of care to live in independently in the community.
Nursing Facility Level of Care Determinations are necessary as a beneficiary must meet the Nursing Facility Level of Care criteria in order to be admitted to a long-term care nursing facility or receive C-waiver services. The MI MI Health Link Program is required to mai maintain program integrity in accordance wit with MDHHS LOCD Policies.
MDHHS is required to submit quality reports t to CMS to ensure waiver members are r receiving quality care from trained p professionals based on the agreed upon c contractual arrangements for MI Health Link. A Audits are conducted annually for quality a assurance, and to confirm waiver service d delivery meets MDHHS and CMS expectations. D Data gathered during annual audits is c compiled and submitted to CMS. Audits i include, but are not limited to, desk r reviews of clinical records, home visits, a and critical incident monitoring.