Medical/Social Services Consultant II

State of Delaware•Dover, DE

About The Position

The incumbent conducts surveys of Nursing Homes and Assisted Living Facilities. Work includes ensuring regulatory compliance for State licensure and/or Medicare/Medicaid certifications; conducting investigations of complaints and allegations of violations of patient and health care regulations involving Nursing Homes and Assisted Living Facilities. The incumbent identifies and documents deficient practices and prepares reports of the findings. May work as part of a survey team or occasionally perform surveys or investigation independently.

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.

Nice To Haves

Professional social services experience in a long-term care facility, intermediate care facility for individuals with intellectual and developmental disabilities, or acute care healthcare setting, including experience evaluating resident/client needs, interdisciplinary care planning, resident rights, and compliance with healthcare regulations.

Responsibilities

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.