About this role
Function(s):
Provides delegated Waiver Service Coordination for MyCare Ohio HCBS Waiver members at Nursing Facility level of care, ensuring person-centered, high-quality support in alignment with agency values and state requirements.
JOB RESPONSIBILITIES:
Provides waiver service coordination for managed care enrollees in the MyCare Ohio program (Waiver Service Coordination delegation)
- Conduct initial and ongoing Waiver Service Needs Assessments using ODM approved tools to determine ongoing program eligibility, care needs, and service options.
- Complete home visits and phone contacts according to assigned tier to ensure health, safety, service satisfaction and provide education to members.
Complete initial and annual Waiver Service Plan (WSP) within 4 days of assessment, using standardized tools for personal care authorizations.
- Collaborate with the Department of Job and Family Service to establish and/or maintain Medicaid eligibility.
- Provide education and support to consumers and their caregivers.
- Complete all required documentation, within 3 business days of the activity.
- Develop, implement and maintain the Waiver Service Plan within 4 calendar days following receipt of the request for Waiver Services for all members. The Waiver Service Plan must include disaster preparedness/back up plans and scope of service to address a member’s unstable conditions.
- Advocate on behalf of consumer and/or caregiver/family and assist individuals in securing appropriate services and care settings.
- Collaborate closely with the Care Coordinator to ensure coordination of care.
- Provide crisis intervention, collaborate with the health plans to complete actions related to critical/reportable incidents, and in developing health and safety action plans (HSAPs).
- Disenroll all ineligible consumers from the program.
- Respond to questions, problems, or complaints from members, providers, and advocates. Apply judgments and perform clinical practice based upon education, experience and professional practice standards.
Qualifications
Required
- Registered Nurse in the State of Ohio or Licensed Social Worker in the State of Ohio; or
- Licensed Practical Nurse in the State of Ohio or approved Social Work Trainee registration; or
- Bachelor of Arts or Science degree in a field related to working with elderly and disabled populations and one year of experience per OAC 174-43-05 (B)(2)(d).; And
- At least one year of experience working with persons with disabilities/chronic conditions and LTSS
Preferred:
- Previous Care Management experience
- One year of experience in home care, geriatrics, behavioral health, or long-term care.
- Knowledge of chronic disease management.