Critical Incident Specialist: Exception Template

Summary:

• Work Mode: 100% Remote, Need to have a PA Licensure
• Duration: 3-month contract, possible extension or conversion
• Shift: Mon - Fri 8am - 5 PM EST (As contingent, OT will not be permissible)

Responsibilities:

• Develop, implement, resolve, and oversee waiver incident reporting at member and organizational levels.
• Provide waiver incident reporting education.
• Conduct incident reporting, investigation, processing, and closure.
• Ensure compliance with company agreements, the Administrative Code, and CMS regulations.
• Confirm eligibility and validate events for reporting upon receipt of new case assignments.
• Review historical events and determine if Trend Analysis is required.
• Maintain internal documentation regarding investigation process status.
• Collaborate and support Service Coordinators with the investigation process.
• Maintain open case volume and evaluate open cases for potential closure.
• Complete event closure when criteria are met, including securing participant health and safety, preventing recurrence, and making necessary changes to the Person-Centered Service Plan.

Requirements:

• Minimum of two years of experience and knowledge of waiver processes.
• Background in Nursing, Social Work, or Case Management is preferred.
• Clinical licensure is preferred but not required; clinical experience in lieu of licensure will be considered.

Preferred Skills:

• Clinical Background
• Case Management Experience
• Waiver Experience/Knowledge