Program Specialist 1 - Children, Youth & Families (HealthChoices)

Northampton County•Bethlehem, PA

1d•Onsite

About The Position

The Program Specialist 1 – Children, Youth & Families - HealthChoices position provides direct supervision to all agency staff regarding managed care, especially as it relates to Children in Substitute Care (CISC). This position is responsible for the continued development of protocols, changes made by the Federal or state government, and the implementation and monitoring of the managed care initiative. This position provides consultation to Children, Youth & Families staff and the Juvenile Probation office on all issues pertaining to HealthChoices.

Requirements

Possession of a Bachelor’s degree with major course work in Sociology, Social Welfare, Psychology, Gerontology, Criminal Justice, or other related social sciences; AND At least two (2) years of full-time professional work experience in social casework in a public or private social services agency.
Public or private social work is defined as professional work identifying and evaluating consumer problems and formulating, implementing, or directing an appropriate service plan. This requires in-depth interviewing to obtain comprehensive information about consumer needs, counseling, providing information about available programs, determining eligibility for program services, and negotiating on behalf of consumers with referral agencies to successfully implement appropriate services.
OR At least one (1) year of full-time work experience as a Program Specialist 1.
Employee assigned to this title will be required to possess and maintain a valid and current motor vehicle operator’s license.
Must have an acceptable driving record.
Personal vehicle required for County business; employee is eligible for mileage reimbursement.
Knowledge of the principles and practices of Children, Youth & Families program planning and development as it relates to the implementation of direct services and operational procedures.
Knowledge of modern basic management principles and practices.
Knowledge of current social, economic, and health problems and resources as it relates to Children, Youth & Families.
Knowledge of the basic principles and methods involved in working with socially maladjusted and physically and/or mentally disadvantaged children and youth.
Knowledge of the structure, organization, and methods of public and private Children, Youth & Families agencies and institutions.
Knowledge of the principles and methods applied to collecting, reviewing, analyzing, and interpreting statistical data.
Ability to analyze and evaluate program plans and operations.
Makes recommendations leading toward policy and method determination.
Ability to aid in the development and coordination of Children, Youth & Families program plans.
Ability to establish and effective working relationships with departmental staff and other agencies.
Ability to compose and present pertinent statements verbally and in writing.
Ability to read, write, speak, understand and communicate in English to perform the duties of this position.

Responsibilities

Oversees all functions and tasks of the Children, Youth & Families HealthChoices unit.
Supervises protocols for Master Client Index (MCI) checks and clearances.
Obtains MCI clarifications from the Department of Human Services and shares with impacted staff to improve work flow and processes.
Ensures completion of fiscal forms for placement of children in foster care, including the determination of Medical Levels of Foster Care.
Monitors changes to Physical Health Managed Care Organizations (PH-MCOs) and Primary Care Physician (PCP) selections for all CISC.
Advocates for the resolution of insurance, billing, and access issues.
Authorizes payment and/or reimbursement of medical bills as the payer of last resort.
Tracks and monitors the insurance, medical, and dental records for CISC.
Assigns workload to staff.
Assesses and conducts Employee Performance Reviews (PERs).
Updates staff on all new regulatory processes.
Schedules regular conferences with staff.
Provides direction, support, and suggestions for handling assigned duties and conflict resolution.
Oversees the reviews of children’s general and special health needs to ensure selection of the Physical Health Managed Care Organization (PH-MCO) most appropriate to meet the needs for children in out of home placement.
Serves as liaison to PH-MCOs and the County’s Behavioral Health Managed Care Organization (BH-MCO).
Provides case coordination as needed both within the Department of Human Services and with outside stakeholders.
Serves as point of contact for all CISC insurance and medication issues, including County P-Card purchases for medications, medical bills received, etc.
Reviews and authorizes all medical bills needing reimbursement.
Participates in the coordination of interagency meetings including County Multi-Systems Team Meetings and Complex Case Meetings.
Provides support to caseworkers with referrals to Developmental Programs, Mental Health, and Child and Adolescent Service System Program (CASSP).
Files grievances for denied services with insurance companies when appropriate or requested.
Participates in agency and inter-agency staffing committees, administrative meetings, unit meetings, Court hearings, etc.
Ensures adequate service provision throughout agency.
Responsible for the general supervision of agency staff regarding managed care issues, serving as a resource to agency staff.
Advises on advocacy strategies to access needed physical and behavioral health services for clients, including resolving insurance issues and assisting with referrals for accessing out-of-network providers when necessary to meet the needs of children in CISC.
Responsible for individual professional growth.
Maintains professional competency by attendance at seminars, workshops, and through review of current professional literature and resources.
Maintains client confidentiality in accordance with state laws and regulations, as well as agency policies and procedures.
Participates in agency and County workgroups and meetings as assigned or agreed to by the Assistant Administrator.
Reviews utilization patterns and other managed care data including updates on providers, Psychotropic Medication Dashboard Report (PMDR), and the Home and Community Services Information Systems (HCSIS) unusual Incident Reports.
Shares pertinent information with colleagues.
Collaborates with Fee-For-Service (FFS) on various issues that occur for those not enrolled in an MCO.
Attends community meetings as agency representative to develop services collaboratively as the needs of consumers change within system limits.