Service Compliance Officer

Summary

Daily care coordination of all non-medical in-home caregiving for ALTCS, private duty, VA, and ALF/IL patients. Will handle a high volume of cases daily and coordinate all staffing needs for their clients. Manage caregiver service delivery and work in concert with the operations teams to staff existing and new client cases daily. Must be able to troubleshoot situations quickly and meet all monthly goals set by the agency. This position requires that you drive alot throughout Maricopa County and be willing to expand into other counties within Arizona. Will require local travel by car back and forth between client homes and the office on a weekly basis. Attend staff meetings multiple times per week and in office coordination while in the field working with clients. Work with several referral sources such as managed care case management, home health, hospice, and a variety of other partners within the community. Must have an expert level understanding of Arizona Medicaid, Medicare, and non-medical caregiving within Arizona. Must demonstrate a servant heart and absolutely love working with people. 

Essential Operations Duties and Responsibilities

Maintain working knowledge of Arizona Long Term Care regulations as they pertain to Home and Community Based Services. Staying up to speed on any changes to Arizona Case Management Handbook and AHCCCS Medical Policy Manual (AMPM) Responsible for the oversight of the client onboarding workflow in addition to a screening of potential clients and their Caregivers for the determination of appropriate services, including applying proper regulations and guidelines related to eligibility, prioritization, and authorization. Responsible for the development of the Client Service Plan and collaboratively working with the MCO Case Manager on any additional documentation that should be included in the Service Plan. Responsible for assigning, introducing, and maintaining open lines of communication with the Client and Assigned Caregiver.

Responsible for the dismissal when warranted of the Client's Caregiver

Provide ongoing monitoring of the client and/or Caregiver’s status to determine the adequacy of services, identify any changes in the client or Caregiver’s condition, and assist with ongoing needs.  Responsible for proper documentation and follow-up after referral of the Client services (e.g. ALTCS/Private Duty). Advocate on the Clients behalf with all involved agencies, MCO, organizations, and individuals.  Reassesses the Clients and/or Caregiver’s service need every 30, 60, 90, and 120 days or as needed.  In collaboration with the Client Case Manager determine when termination of services is appropriate, and the case should be closed.  Responsible for the documentation and communication to the Case Manager of any incidents that occurred during the Caregiver shift. 

Must follow incident reporting policy and procedure as dictated by the agency. 

Responsible for identifying, planning, authorizing, arranging, negotiating, coordinating, monitoring, and managing costs of the service plan.  Responsible for ensuring that Clients and Caregiver or informal support system receives appropriate services and that the services received are of high quality.

Qualifications and Skills

Experience in dealing with third party-provided services Operational ability in a diverse, large-scale environment Exceptional customer-facing skills In-depth knowledge of escalation procedures, incident management, and other disciplines related to service delivery Expertise in people management and de-escalation techniques Strong organizational skills Capacity to train and guide junior team members Ability to manage and prioritize tasks efficiently Solid resource planning and problem-solving aptitudes Readiness to demonstrate a proactive attitude Excellent verbal and written communication skills Working knowledge of Arizona Medicaid ALTCS, Medicare, and other HCBS services within our Arizona Community. Must be able to obtain a Level One Fingerprint Clearance Card Must have a good standing driving record and driver license Must be able to obtain all credentials set-forth by Arizona AHCCCS Must have excellent communication skills and ability to work independently and both as a team member.