Adult Medicaid Long Term Care - Eligibility Caseworker III

J  o  b    D  e  s  c  r  i  p  t  i  o  n

Job Information

Title:

Adult Medicaid Long Term Care - Eligibility Caseworker III

Market Range:

MR15

Approved Date:

2/19/2024 11:54:43 AM

FLSA:

Non-Exempt

EEO Code:

PROFESSIONALS

Career Level:

C3

Career Level Description:

Core Services Level 3

Job Code:

100021

Job Family:

Social Services

Sub Family:

Economic Services

Primary Purpose

Determines eligibility for Adult Medicaid, Special Assistance, Long Term Care based on factors such as income, family size, medical information, medical evaluations/ health conditions, resources, deductible expenses, and needs. Interacts with clients, agencies and facilities to provide information about services provided or to gather needed information about client/recipient.

•

Determines initial and/or ongoing eligibility for Adult Medicaid, Long Term Care, Special Assitance and CAP.

1

20%

•

Interviews clients to gather information needed for application/case. Assesses and evaluates information received to evaluate needed information.

2

20%

•

Enters all required data and documentation into online and electronic systems to authorize benefits.

3

20%

•

Sends proper notices; requests for information, case actions and case decisions.

4

10%

•

Responds to clients, agencies and facilities inquiries, phone calls, emails.

5

10%

•

Manages queues and workflows in Onbase, NCFast and other systems as needed.

6

10%

•

Researches new policy and procedures utilizing Medicaid manual, NCFast Help, Admin letters and consults with Team Lead and/or Supervisor.

7

5%

•

Completes accurate, detailed daysheets and timesheets

8

5%

Position(s) may perform other duties in addition to the above as assigned by management.

•

Loga hearing requests and attends hearings timely.

•

Attends staff meetings; participatea in division and section workgroups.

•

Completea county and program trainings, both optional and required.

•

Performa other duties as required.

•

*IMPORTANT* In the event of an emergency, as determined by the County Manager or designee, participation in preparedness and response operations should be expected. Employee may be required to fill a temporary assignment in a role different from standard duties, work hours and/or work location in preparation for, during and after the emergency. Employee may also be required to participate in relevant exercises and regular preparedness training.

Career Level Dimensions

Career Level:

C3

Career Level Description:

Core Services Level 3

•

Works to deliver day-to-day objectives that directly impact the achievement of results for the Work Group.

•

Work consists of tasks that are typically not routine.

•

Works independently under limited supervision, applying discretion when required.

•

Responsible for recommending adjustments to processes or systems that improve the effectiveness of the Work Group.

•

May be required to apply discretion within broad operational boundaries and procedures.

•

Communicates within and outside Work Group to obtain information or explain practices and policies.

•

Responsible for providing, guidance, coaching, and training to lower-level support employees.

•

Requires broad knowledge of operational systems and practices typically gained through extensive experience, technical training, and/or advanced education.

Qualifications

•

Associate's degree in Human Services or a related field

•

Two years of job-related experience

•

Valid Driver's License and "safe" driving record

•

Equivalent education and experience are accepted

•

2 Years

Experience determining eligibility in Adult Medicaid, Long Term Care, Special Assistance. 

•

2 Years

Experience determining eligibility for a Financial or Insurance Provider for financial assistance or insurance claims.

•

2 Years

Experience working with relevant technology (software and systems) to meet business needs (e.g., Microsoft Office, NC FAST, and OnBase).

•

•

Knowledge and strong understanding of Adult Medicaid policy; interprets new and changed policies and able to explain Medicaid policy to beneficiaries, family members, and facility representatives.

•

Identifies issues, obtains relevant information, relates and compares data from different sources, and identifies alternative solutions.

•

Excellent organizational skills and ability to maximize the use of time so that the many diverse tasks associated with the position can be completed in a timely manner.

•

Experience assessing the financial capabilities and need for financial assistance (e.g. Financial Counseling).

•

Develops and maintains strong relationships with clients, representatives and other agencies by listening and understanding and responding to identified needs.

•

Accomplishes tasks and processes accurately and completely.

•

•

•

An individual must be able to perform each essential duty satisfactorily to perform this job successfully. The requirements listed above are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Competencies

Quality Assurance

Produces results or provides service that meets or exceeds organizational standards. May audit the work of others to ensure quality standards are met.

Problem Solving

Builds a logical approach to address problems or opportunities or manage the situation at hand by drawing on one's knowledge and experience base, and calling on other references and resources as necessary.

Customer Service

Balances interests of a variety of clients, and readily readjusts priorities to respond effectively to pressing and changing demands for information, advice and assistance.  Anticipates and meets the needs of clients; achieves quality end products; and commits to continuous improvement of services.

Adaptability & Flexibility

Changes behavioral style or method of approach when necessary to achieve a goal; adjusts style as appropriate to the needs of the situation. Responds to change with a positive attitude and a willingness to learn new ways to accomplish work activities and objectives.

Attention to Detail

Thoroughness in accomplishing a task through concern for all the areas involved, no matter how small. Monitors and checks work or information and plans and organizes time and resources efficiently.

Professionalism

Thinks carefully about the likely effects on others of one's words, actions, appearance, and mode of behavior. Selects the words or actions most likely to have the desired effect on the individual or group in question. Maintains calmness in stressful or adverse situations. Diplomatically handles challenging or tense interpersonal situations.

Communication

Creates an atmosphere in which timely and high-quality information flows smoothly up and down, inside and outside of the organization; encourages open expression of ideas and opinions.

Integrity

Act with honesty, transparency and respect in our interactions with co-workers and those we serve. Adhere, without exception, to laws, policies, procedures and professional standards.

Accountability

Establish high-quality standards for work. Add value. Measure results and hold self and others accountable for making progress toward desired outcomes. Take a logical and data-driven approach to decision-making.

Diversity

Believe that different backgrounds and experiences strengthen the organization and produce better results. Value inclusion across race, gender, age, religion, identity and experience, and strive to reflect in our workforce the diversity of our community.

Collaboration

Foster a work culture in which different ideas and opinions are encouraged and expected. Listen carefully and speak thoughtfully. Work together toward shared goals with mutual respect and cooperation.

Continuous Improvement

Continuously improve work processes and products. Provide a safe environment to be innovative and creative and try new things. When things don't go as planned, use it as an opportunity to learn, regroup and begin again. Provide time and resources for individuals to grow and develop both personally and professionally.

Wellness

Take proactive steps to be physically fit and healthy, emotionally strong, financially secure and socially fulfilled, while inspiring and empowering others to do the same.

Service Orientation

Commit to making a difference within the community. Actively engage in and enjoy our work. Deliver services that exceed expectations, with courtesy, politeness and sensitivity to the experiences, concerns and feelings of all co-workers and customers.

ADA Checklist

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

Standard ADA Selection:

Office Environment

Standing

X

Walking

X

Sitting

X

Lifting/Carrying 0-10 pounds

X

Lifting/Carrying 10-20 pounds

X

Lifting/Carrying 20-50 pounds

X

Lifting/Carrying 50-100 pounds

X

Pushing

X

Pulling

X

Climbing

X

Balancing

X

Stooping

X

Kneeling

X

Crouching

X

Crawling

X

Reaching

X

Handling

X

Grasping

X

Fingering

X

Feeling

X

Talking

X

Hearing

X

Visual Perception

X

Repetitive Motions

X

Eye/Hand/Foot Coordination

X

Memorization/Concentration

X

Learning/Knowledge Retention

X

Preparing/Analyzing Numerical Figures

X

Use of Interfaced Commmunication Devices (Phone, Computer, Radio etc.)

X

Analyzing/Examining/Testing Data

X

Emotional/Behavioral Self-Regulation

X

Interacting with Others

X

Comprehension

X

Organization

X

Decision Making

X

Comprehension

Understand and apply routine verbal and/or written instructions

Organization

Organize and prioritize individual work schedule to manage multiple tasks and/or projects

Decision Making

Make decisions that have an impact on the individual's work

Communication

Communicate and explain a variety of information

Extreme cold

X

Extreme heat

X

Humid

X

Wet

X

Noise

X

Hazards

X

Temperature Change

X

Atmospheric Conditions

X

Vibration

X

Computers/Monitors

X