Job Information
STATE OF NEW HAMPSHIRE - Department of Health & Human Services LONG TERM CARE MEDICAL ELIGIBLITY PROGRAM SPECIALIST (Job ID: 44882) in Concord, New Hampshire
LONG TERM CARE MEDICAL ELIGIBLITY PROGRAM SPECIALIST
(Job ID: 44882)
Location: US:NH:CONCORD OccupationCategory:13-0000 Businessand FinancialOperationsOccupations Employment Type: FULL-TIME Post Date: 11/20/2024 Close Date: 01/07/2025 Salary: 28.740-38.850USD
State of New Hampshire Job Posting
Department of Health and Human Services
Bureau of Developmental Services
Concord, NH
LONG TERM CARE MEDICAL ELIGIBLITY PROGRAM SPECIALIST
#17165
The starting pay range for this position is $28.74-$38.85 hourly
*See total compensation information at the bottom of announcement.
The State of New Hampshire, Department of Health and Human Services, Bureau of Developmental Services has a full time vacancy for Long Term Care Medical Eligibility Program Specialist.
SUMMARY:
Conducts medical eligibility determinations and reviews for Medicaid categorical disability programs and authorizes waiver eligibility for the Home and Community Based Care waivers in accordance with Federal, State and Medicaid regulations.
RESPONSIBILITIES:
Applies knowledge, judgment and skills in assessing and evaluating the needs of individual applicants to determine eligibility and level of care through a review of medical and functional data including but not limited to, medical reports, exams, psycho-social evaluations, clinical data, occupational and vocational information.
Performs reviews, at least annually, to determine continuing eligibility and level of care for identified Medicaid programs. Reviews, evaluates, monitors and supervises the effectiveness of case management services provided by contracted agencies and staff.
Analyzes, authorizes, records and approves Medical eligibility requests for home, specialized medical equipment and environmental modifications. Supporting documentation is documented in multiple systems including New Heights, NHEASY, Options, Budget Tracking System (BTS), NH Leads, and Medicaid Management Information Systems (MMIS).
Provides assurances and program integrity using all eligibility determination instruments such as the Supports Intensity Scale (SIS); Health Risk Screening Tool (HRST); Functional Screen; and, Scales of Independent Behavior - Revised (SIB-R).
Reviews assessments of all applicants who do not meet medical eligibility criteria and skillfully assesses additional medical, surgical and or diagnostic information provided by the applicant in support of his or her need for therapeutic/medical long-term care (LTC) services. Prepares case documentation and the development of testimony as required in preparation for Administrative Appeals hearings in long term care cases.
Expedites medical record collection process when necessary by contacting area agencies and/or health care providers directly via phone, email or fax on behalf of applicants, recommends additional evaluations when further information is needed to support waiver eligibility.
In consultation with, and as designated by Management, participates in the training, supervision and evaluation of subordinate staff and contracted consultants assigned to determine eligibility.
Works with management to identify changes to policies, procedures and informational tools that will enhance productivity and improve operational effectiveness. Participates in continuous quality improvement workgroups convened to address areas requiring improvement.
Assists, when requested, with the Bureau of Elderly and Adult Services eligibility.
MINIMUM QUALIFICATIONS:
YOUR EXPERIENCE COUNTS:
Each additional year of approved formal education may be substituted for one year of required work experience and/or each additional year of approved work experience may be substituted for one year of required formal education.
Education: Master's degree from a recognized college or university with major study in nursing, geriatrics, social work, counseling, education, psychology, human services, rehabilitation, or a related field. Each additional year of approved formal education may be substituted for one year of required work experience.
Experience: Four years' professional experience in nursing, social work, counseling, human services, determining medical eligibi
