Medical/Social Services Consultant II

State of Delaware•Dover, DE

About The Position

An incumbent in this class is responsible for ensuring the regulatory compliance of acute and continuing care facilities/agencies in Delaware. The duties include conducting federal certification and/or state licensure surveys for all types of healthcare facilities/agencies, assessing the quality of care and relating findings to statutory/regulatory requirements, developing deficiency reports, reviewing/assessing corrective action plans, participating in updating healthcare regulations, and maintaining records. You may be required to appear in courts of law or before a hearing officer or boards/commissions. Essential functions are fundamental, core functions common to all positions in the class series. These functions are not an exhaustive list of all job duties for any one position in the class. Since class specifications are descriptive and not restrictive, employees can complete job duties of a similar kind not specifically listed here. Manages cases over the continuum of a healthcare delivery system for clients with complex, chronic, and specialized physiological medical conditions. Facilitates access to medical and social service resources across public, private, and community sectors. Collaborates with health care providers, services, programs, and insurance entities to develop tailored service plans and interventions. Integrates care and communication between stakeholders to ensure optimal health and social outcomes. Navigates and consults on the intersection of services, authorizations, and payments between the clients, providers, insurance programs and/or Managed Care Organizations. Works with providers and insurance entities to obtain pre-authorizations and referrals. Schedules and attends multidisciplinary evaluations and assessments. Facilitates and participates in discharge and transition planning. Formally responds to casework inquiries and investigates complaints, assessing services or eligibility against legal entitlements or contracts. Provides subject matter expertise through outreach and education to program staff, community members, providers, and other stakeholders through special community events or health education and preventative services. Advocates for community health and wellness. Maintains and tracks service, eligibility, and referral data sets, manages data for reporting and program planning. Coordinates and allocates funding sources for special program eligibility. May support emergency preparedness and response efforts during pandemics or natural disasters, and/or intervene in facilitating care for clients in health crisis. May provide home visits, and/or virtual appointments. Performs other related duties as required.

Requirements

Possession of a Bachelors degree or higher in Health, Behavioral or Social Science or related field.
Two years' experience in case management such as assessing, planning, developing, implementing, monitoring, and evaluating options and services to meet an individual's human service needs.
Two years' experience in making recommendations as part of a client's service plan such as clinical treatment, counseling, or determining eligibility for health or human services/benefits.
Two years' experience in client healthcare resource coordination and support.
Six months experience in interpreting laws, rules, regulations, standards, policies, and procedures.
Six months experience in narrative report writing.

Responsibilities

Ensuring the regulatory compliance of acute and continuing care facilities/agencies in Delaware.
Conducting federal certification and/or state licensure surveys for all types of healthcare facilities/agencies.
Assessing the quality of care and relating findings to statutory/regulatory requirements.
Developing deficiency reports.
Reviewing/assessing corrective action plans.
Participating in updating healthcare regulations.
Maintaining records.
Managing cases over the continuum of a healthcare delivery system for clients with complex, chronic, and specialized physiological medical conditions.
Facilitating access to medical and social service resources across public, private, and community sectors.
Collaborating with health care providers, services, programs, and insurance entities to develop tailored service plans and interventions.
Integrating care and communication between stakeholders to ensure optimal health and social outcomes.
Navigating and consulting on the intersection of services, authorizations, and payments between the clients, providers, insurance programs and/or Managed Care Organizations.
Working with providers and insurance entities to obtain pre-authorizations and referrals.
Scheduling and attending multidisciplinary evaluations and assessments.
Facilitating and participating in discharge and transition planning.
Formally responding to casework inquiries and investigating complaints, assessing services or eligibility against legal entitlements or contracts.
Providing subject matter expertise through outreach and education to program staff, community members, providers, and other stakeholders through special community events or health education and preventative services.
Advocating for community health and wellness.
Maintaining and tracking service, eligibility, and referral data sets, managing data for reporting and program planning.
Coordinating and allocating funding sources for special program eligibility.
Supporting emergency preparedness and response efforts during pandemics or natural disasters, and/or intervening in facilitating care for clients in health crisis.
Providing home visits, and/or virtual appointments.