Case Manager - Medicaid Eligibility

SUMMARY

Provides case management through advocacy, linkage, and/or referral, for immediate needs as well as addressing other needed services and skills training to clients who require frequent contact in order to maintain community tenure, by performing the following duties.

EOE Statement

We are an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

• Coordinates the needs of clients and family members with resources available and provides client advocacy as needed.
• Assists clients in finding and accessing insurance resources needed to maintain
• Health insurance coverage.
• Establishes rapport with clients, assessing client Medicaid eligibility, explaining benefits of Medicaid coverage and assisting client in making informed decision regarding their insurance coverage.
• Adheres to agency policy and procedures, as found in the Forms Locked drive on each computer. Also adheres to CARF and DMHSAS standards and criteria, federal and state confidentiality rules and regulations, and any special funding source requirements including Medicaid and HCA regulations.
• Supports and promotes a service environment for individuals in need of behavioral health and/or co-occurring services that is recovery focused, welcoming, and attentive to the needs of individuals who may have experienced trauma in their lives. Attends annual core competencies training in relationship to individuals with co-occurring disorders or who have experienced trauma in their lives.
• Establishes and maintains professional working relationships with supervisor and peers. Can effectively work within a team or group setting cohesively.
• Works closely with assigned program staff to coordinate appointments with clients nad share relevant information regarding their benefits.
• Monitors eligibility status of clients for Social Security, Title XIX (Medicaid), QMB, Medicare and other benefits for which the client may qualify for and seeks to assist eligible clients in the Health Home Services/enrollment.
• Reviews and maintains up-to-date address, phone number, contact persons, and financial information on all clients.
• Establishes rapport with clients, assessing client needs; organizes, plans, and delivers face-to-face client services; and conducts follow up on the outcome of services provided.
• Responsible for maintaining strictest confidentiality guidelines for interactions regarding consumer and family information.
• Provides a minimum of 85 hours billable services with consumers per month.
• Utilizes the philosophy of Collaborative/Therapeutic Documentation to meet clinical record keeping documentation standards and ensure documentation is completed with the Consumer to the extent possible and all documentation is completed on the same day of the date of service. Reports and documents services in accordance with agency policy and procedures.
• Responsible for seeking out supervisory assistance for additional training and to enhance skill set as needed.
• Interacts with other professionals to discuss therapy or treatment, new resources or techniques, and to share information.
• May be required to work evening or weekend hours.
• May be required to provide services in a community setting.
• Must be able to provide client transportation using personal vehicle or agency owned van or small bus.
• Performs other related duties as assigned.

QUALIFICATIONS To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION and/or EXPERIENCE

Bachelor's degree in psychology, social work, or other related mental health field; or High school diploma with 36 total months of experience working with persons who have a mental illness.

CERTIFICATES, LICENSES, REGISTRATIONS

• Required to obtain and maintain DMHSAS CM Certification.
• Required to complete, Therapeutic Options or approved safety training and annual updates.
• May be required to obtain and maintain First Aid and CPR Certifications.
• May be required to complete and maintain Wellness Coach Certification
• In order to provide client transportation, must possess current, valid Oklahoma license, meet HOPE insurance requirements. HOPE will annually obtain copy of Motor Vehicle Record from the Department of Public Safety.

LANGUAGE SKILLS

Ability to read and comprehend basic instructions, correspondence, and memos. Ability to write correspondence to courts, schools, etc. Ability to effectively present information in one-on-one and small group situations to families, clients, and other employees of the organization. Ability to complete thorough and accurate clinical documentation and writing in a medical record chart and complete needed paperwork.

REASONING ABILITY

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations. Ability to seek out supervisory assistance for additional training when needed and make application of techniques or other skills to meet essential job duties and responsibilities.

OTHER SKILLS AND ABILITIES

• Ability to relate to persons with severe mental illness and/or substance use in a positive, helpful, and constructive manner.
• Ability to establish and maintain effective and tactful working relationships with co-workers; to express ideas and facts clearly and concisely in written or oral form.
• Personality and mature presentation of oneself demonstrating the ability to work with various systems while maintaining objectivity and cooperative attitude.

PHYSICAL DEMANDS

• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• While performing the duties of this job, the employee is frequently required to talk or hear. The employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; and climb or balance. The employee must occasionally lift and/or move up to 25 pounds. The employee must have vision enough to read written or typed data. Must have hearing and speech enough to communicate effectively with staff, clients, and public in person or by phone.

WORK ENVIRONMENT

• The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• While performing the duties of this job, the employee occasionally works in outside weather conditions. The noise level in the work environment is usually moderate.