Health Care Coordinator 1 - Underfill

State of Nevada • Las Vegas, NV

9h • Onsite

About The Position

The Aging and Disability Services Division (ADSD) is currently recruiting for a Health Care Coordinator 1 in Las Vegas. This recruitment will be used to underfill positions within the Health Care Coordinator series. Advancement to the next level may occur after meeting the minimum qualifications, satisfactory performance, and with endorsement of the appointing authority. This recruitment may be used to fill current and future vacancies as they occur in the following programs: Home & Community Base Services- Supportive Services (HCBS) and Facility Outreach and Community Integration Services/Money Follows the Person (FOCIS/MFP).

Positions assigned to the HCBS - Supportive Services program ensure a coordinated support system to meet the needs of at-risk elderly and people with a disability by providing case management and essential services to recipients of HCBS - Supportive Services programs statewide to facilitate community integration and avoid institutionalization. Responsibilities include case management, assessment, eligibility determination, development, implementation, and oversight of the care plan, home visits and documentation utilizing a web-based case management software system.

Positions assigned to the Facility Outreach and Community Integration Services (FOCIS) ensure a coordinated support system to meet the needs of at-risk Nevadans by connecting and facilitating community resources for recipients to avoid institutionalization. Responsibilities include care coordination, assessments, home/facility visits, and documentation utilizing an electronic system of record keeping.

ADSD fosters a positive, inclusive, and diverse work environment that values innovation, teamwork, and collaboration. The mission of ADSD is to empower individuals and their support systems by providing resources for disabilities and aging - connecting Nevadans to services and improving their quality of life.

Health Care Coordinators perform professional work related to program operations and auditing providers to ensure compliance with program policies and regulations. They evaluate individuals referred to the medical services program and provide ongoing case management services to Medicaid eligible clients; evaluate the need for medical services, treatment, equipment and supplies and authorize payment; screen individuals to determine appropriate level of care in nursing homes; review programs to ensure services are being provided in a cost effective manner; participate in program development by providing input on policies and procedures, forms, medical coverage and system enhancements.

Requirements

• Licensure as a Social Worker or professional licensure or certification in a medical specialty applicable to the assignment.
• General knowledge of: theories, principles, practices, and methods of social work, nursing, or a health care field applicable to program assignment; dynamics of human behavior including interpersonal relationships and social interactions; client rights and confidentiality of information; case management practices; physical, psychological and social characteristics associated with human development.
• Ability to: recognize basic medical and social needs; effectively interact with people of various social, cultural, economic, and educational backgrounds; communicate effectively both orally and in writing to obtain information, explain policies and procedures and persuade others to seek or accept needed services; analyze information, problems, and situations and reach logical conclusions; compose concise, logical, and grammatically correct correspondence, case narratives and reports; read and understand technical materials; assemble, analyze and report data; organize and prioritize work; work independently and as part of a team; operate a computer sufficient to enter, store and retrieve data.

Responsibilities

• Assess potential client needs for case management services using assessment tools to identify social service and/or medical needs; develop and implement plans of care for those determined to be eligible for services; counsel and refer clients to services and/or contract with providers for services; maintain contact with clients through home visits and telephone calls; monitor the quality and cost of services provided to clients; periodically update plans of care; submit payment authorization requests; and maintain case files.
• Participate in periodic reviews of facilities providing care to Medicaid eligible clients to validate and ensure adequacy of services and resident care; ensure reimbursement matches the cost of services provided; monitor nursing facility quality indicator reports; screen and assess Medicaid clients regarding discharge to community-based care; review medical records; document findings and deficiencies on appropriate forms; prepare reports of findings and participate in exit conferences; participate in independent professional reviews of providers to determine the quality of care, compliance with patient rights, and appropriateness of placement as assigned.
• Review health care providers and fiscal agents to ensure clients are receiving appropriate services and payment is correct for services received; ensure providers and fiscal agents are in compliance with division policies and procedures; ensure employee health, certification and training needs are appropriate and properly documented in personnel records; verify client records have appropriate documentation and that authorized services correlate with services provided; confirm termination of services were appropriately documented and mandated reporting requirements were met; provide technical assistance regarding policies and procedures; complete written documentation using appropriate format; identify areas needing improvement and review plans of correction.
• Process payment authorization requests from providers to ensure the requested service, treatment, equipment or supplies are medically necessary and in compliance with Medicaid criteria prior to approving or denying requests; review pertinent medical information and previous requests; evaluate medical necessity to justify payment by comparing the diagnosis and other medical information with the request; refer requests to a medical consultant for another medical opinion as necessary; render determinations in accordance with Medicaid policy and notify providers of decisions.
• Review records from the fiscal agent, providers, clients and computer generated reports in order to identify abuse and potential fraud and to ensure claims were paid properly by the fiscal agent; refer financial errors to the fiscal agent for adjustment of charges and refer potential cases of fraud and abuse for further investigation.
• Explain proper billing procedures to contract providers selected by the client; monitor the quality of care given by the provider to clients; and submit billings for services provided to the fiscal agent for payment.
• Perform related duties as assigned.
• Under direct supervision, incumbents become familiar with Medicaid policies and procedures and receive training in the range of duties described above.
• This is the entry level in the series and progression to the journey level may occur upon successful completion of the probationary period, meeting the minimum qualifications, and with the recommendation of the appointing authority.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed