Bachelor’s Degree required. Knowledge of EPD Waiver Program preferred.
Must be familiar and understand with District of Columbia’s EPD Waiver program, processes, regulations and DCCC.
Two (2) years experience in home health preferred.
Must be computer literate, self motivated, and reliable.
Master’s degree preferred. FLSA Status: Exempt Position Summary The Case Management Coordinator will plan and coordinate care activities for the professional Case Managers.
The position will interpret agency policies and regulations for all social work personnel to ensure compliance.
Collaborates with Administrator and Clinical Manager in an administrative capacity.
Assist in maintaining compliance with Federal and state laws/regulations, as well as VMT’s policies/procedures.
Duties and Responsibilities * Utilize, and train as necessary others to utilize, the Department of Health Care Finance (DHCF) software system (Case Net) to complete all work for the EPD Waiver recipients.
* Ensure that initial, recertifications and monthly visits are submitted within the required timeframe
* Track and address any concerns with Case Manager documentation in DC Care Connect (DCCC)
* Track and monitor EPD Waiver hospitalizations and institutionalization status and send out discharge letters as needed.
* Track and monitor EPD beneficiary Plan of Care Revised February 2019
* Track and monitor the progress of initial applications with ADRC and assigned case management agency.
* Track and monitor the recertification process of all expiring or expired Prior Authorizations and eligibility
* Track and monitor that all recertifications are submitted 120 days prior to the expiration of the Prior Authorization
* Review daily visit notes submitted by case managers and notify the Administrator and Director of Clinical Services of any issues that need to be addressed
* Ensure that all EPD Waiver beneficiary’s plan of PCSP are completed and forwarded to assigned RN
* Track and monitor each month that coordination of care is completed by each Case Management Agency with each beneficiary and documented in DCCC
* Upload required documents into DCCC as needed
* Verify that the services requested are the services the beneficiary authorized to receive
* Ensure to protect the rights of the beneficiaries and adhere to the beneficiary’s freedom of choice.
* Ensure and provide the beneficiaries rights including appeal rights.
* Follow up on adjustments in services with Case Managers as needed to ensure the beneficiary is receiving the services that are needed.
* Attend monthly EPD Waiver meetings or request updates if unable to attend
* Keep the beneficiary and the Case Management Provider informed of any pending change in services and ensure the rights to a fair hearing are included for the beneficiary.
* Becomes familiar with State and Federal regulations regarding Home Health Care and operations as well as the Waiver regulations.
* Collaborate with other Providers to discuss beneficiary the needs/problems; reviews the PCSP and plan of care to ensure updates are inclusive of Case Manager resolution recommendations
* Review discharge documentation including summaries, linkages to community resources and plans for follow-up with Case Managers
* Participates in personal, professional growth and development by attending appropriate education programs and conferences
* Regularly evaluate the needs for continuing care of the client
* Ensure that coordination of care is being conducted by the case managers with the nursing staff and is documented in DCCC monthly
* Report monthly to Administrator any issues and resolution of issues Revised February 2019
* Facilitates transfer of clients with Case Management Agency as needed
* Other tasks as assigned Additional Responsibilities
* This description incorporates the most typical duties performed.
It is recognized that other, related duties not mentioned may also be performed.
The position requires the ability to work effectively in a cross-functional environment.
Knowledge and Skills Required * In the event that the Supervisor is not available the incumbent must posses the capability to make correct assessments of priorities and to take the necessary action to either resolve issues, refer them to appropriate, available senior staff members, and/or communicate them to the appropriate supervisor.
In addition, the person who holds this position must have:
* The ability to maintain confidentiality in all matters.
* Excellent organizational skills. * The ability to perform all responsibilities in a highly independent and professional manner consistent with the organizational goals of VMT.
* The ability to adjust to multiple organizational structures in an independent and professional manner.
* The ability to work as a team member handling issues in a fast-paced environment.
* The ability to conduct all verbal and written communication with courtesy, responsiveness, thoughtfulness and care.
* The ability to adhere to timelines and plan effectively with attention to detail and accuracy.
* The ability to upload documents in to DCCC.
* The ability to evaluate and prioritize issues and assist in their resolution
* Efficiency, creativity, and flexibility.
* The ability to project a professional company image through in-person and phone interaction.
* The ability to make all professional decisions with a focus on the total satisfaction of both internal and external constituencies.
* The ability to use appropriate, professional judgment in the best interests of the corporation for all decisions.
* The ability to initiate, establishes, and maintains positive working relationships and strong rapport with others in a team environment.
* The ability to respond receptively to constructive criticism and coaching.
* The ability to represent the corporation both among staff and vendors using the highest standards of professional integrity.
Duty Hours • Hours are flexible and are directly based upon the efficient performance of duties outlined above.
This position current responsibility authorizes the use and disclosure of Protected Health Information within the scope of the Privacy Security Policies and Procedures of VMT Long Term Care Management, Inc., to perform functions, activities, or services for, on behalf of the organization for purposes of treatment, payment and health care operations.”
Location/Region: Washington, DC (20024)