LOCATION: Remote – This is a home based, virtual position that operates Monday – Friday from 8:30am-5:00pm EST. Vaya Health welcomes applications from NC, SC, GA, TN, VA, MD, and FL.
GENERAL STATEMENT OF JOB
The Innovations Access Coordinator is responsible for ensuring that eligible members can access NC Innovations Waiver slots quickly and efficiently. This individual works closely with the Utilization Management (UM) team and the Member and Recipient Services (MRS) Department to execute processes that facilitate slot access. The Innovations Access Coordinator has frequently communication with prospective Waiver participants and legally responsible person (LRPs) in their role. The position is responsible for maintaining tracking of this process, producing reports and working with outside stakeholders including providers and the Department of Social Services (DSS) at the county level.
ESSENTIAL JOB FUNCTIONS
Coordination of new NC Innovations Waiver slot offers (routine turnover and new slot requests):
- Gather the information necessary from members/LRPs to assess the need for I/DD services and complete enrollment.
- Request, gather, and review assessments, evaluations, and medical documentation necessary to determine eligibility for services and/or placement on the NC Innovations Waiver Registry of Unmet Needs (RUN).
- Request Level of Care (LOC) forms for initial requests and as needed if LOCs expire prior to services starting.
- Assist members/LRPs with coordinating needed assessments to determine potential eligibility of I/DD services when these are out of date or unavailable.
- Educate members/LRPs regarding benefit structures, verification of benefits, and information about the North Carolina Medicaid Managed Care system.
- Refer members to appropriate Vaya network providers to meet clinical and geographic needs.
- Divert members to alternative community resources when necessary.
- Provide information on available services for which members may be eligible, seeking consultation from supervisor or other UM I/DD staff as needed.
- Mail letters and offer packets to members/LRPs
- Contact and communicate with local county DHHS offices regarding Medicaid eligibility.
- Maintain NC Innovations Waiver Slot Report and other reports as needed.
Manage NC Innovations Waiver slot allocation of reserved capacity and non-reserved capacity slots:
- Work with local Community Alternatives Program for Children (CAP/C) case workers to identify potential members for age-out slots.
- Work with families and provider-based Tailored Care Managers to gather needed information and documentation to complete emergency slot requests.
- Staff reserved capacity requests with the Behavioral Health/IDD/Traumatic Brain Injury (BH/IDD/TBI) UM Director when Vaya-based Tailored Care Management is not involved.
Other Duties as Assigned.
KNOWLEDGE, SKILLS, & ABILITIES
- A demonstrated knowledge of the assessment and treatment of developmental disabilities, with or without co-occurring mental illness, is a necessity. Additionally, the incumbent should be able to learn and understand legal, waiver and program practices/requirements and apply this knowledge to problem-solve and adequately respond to questions/inquiries.
- This position requires exceptional interpersonal skills, highly effective communication ability, and the propensity to make prompt independent decisions based upon relevant facts and established processes. Problem solving, negotiation, and conflict resolution skills are essential to balance the needs of both internal and external customers.
- The employee must be detail oriented, able to independently organize multiple tasks and priorities, and to effectively manage an assigned caseload under pressure of deadlines.
- Proficiency in Microsoft Office products (such as Word, Excel, Outlook, etc.) and Vaya information systems is required.
EDUCATION & EXPERIENCE REQUIREMENTS
Bachelor’s degree in Special Education, Psychology, Social Work or closely related Human Services area required and 2 years of post-degree professional experience working with the population served.
*Must meet the criteria of being a North Carolina Qualified professional in 10A NCAC 27G .0104
PHYSICAL REQUIREMENTS
- Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading.
- Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists and fingers.
- Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time.
- Mental concentration is required in all aspects of work.
RESIDENCY REQUIREMENT: The person in this position must live in NC, SC, GA, TN, VA, MD, and FL.
SALARY: Depending on qualifications & experience of candidate. This position is non-exempt and is eligible for overtime compensation.
DEADLINE FOR APPLICATION: Open Until Filled
APPLY: Vaya Health accepts online applications in our Career Center, please visit https://www.vayahealth.com/about/careers/.
Vaya Health is an equal opportunity employer.
