Income Maintenance Caseworker II - Long Term Care

Position Description

Performs administrative and technical work to correctly determine an applicant's eligibility for Adult Medicaid. Employees in this class are responsible for the total process of determining or re-determining applicant eligibility in income maintenance programs which includes the intake, processing, and review functions. Work involves intake, processing application and on-going maintenance. Employee should have good judgement, scheduling and decision-making skills. Work involves in-person client contact and/or telephone contact. Employees in this class have additional responsibility to include a higher-level Adult Medicaid responsibility and knowledge, specifically in the areas of Long-Term Care, Program of All-intensive Care for the Elderly (PACE), Community Alternatives Program (CAP), Special Assistance In-Home Program Eligibility, and special SSI cases. The complexity of this work requires a greater level of analysis and evaluation, coordination with internal and external providers, and policy knowledge. The employee will have considerable interaction with nursing and assisted living facilities, Health Keeperz, PACE, authorized representatives, social workers, and family members. This position reports directly to an Income Maintenance Supervisor II and is under the general direction and supervision of the Economic Services Administrator.

Responsibilites

• Interviews client and/or family members to obtain necessary information for application, redetermination and changes in the client's situation.
• Contacts persons and various organizations as required to verify information obtained on the application and/or re-certification form.
• Conducts verifications according to policy and complete only when necessary.
• Obtains all necessary information.
• Evaluates in accordance with program policy and procedures to determine eligibility.
• Enters all information into computer.
• Notifies client as to the status of their eligibility.
• Evaluates five years of bank statements to determine if transfers occurred causing the client to be sanctioned.
• Evaluates deeds for any transfer of property causing a client to be sanctioned.
• Determines accurate patient monthly liability for long term care.
• Communicates to the client and family members the policies and protocols for more difficult programs.
• Assumes responsibility for applications that require more extensive troubleshooting and/or engagement with outside agencies to gather required information and to make eligibility decisions.
• Engages in enrollment and eligibility of Medicaid activities including intake, acceptance, eligibility determination, output, case maintenance, customer service and routine update/inquiries into NC FAST.
• Works with generated reports, as indicated by Supervisor.
• Attend all required / suggested trainings.
• Performs related duties as required.
• In the event of an emergency, as determined by the County Manager or designee, participation in preparedness and response operations is expected. Employee is 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 is also required to participate in relevant exercises and regular preparedness training.

Knowledge, Skills, & Abilities

• Ability to read and comprehend rules and regulations (state and federal policies), including frequently changing policies and guidelines pertaining to public assistance programs.
• Ability to interpret agency's policies and procedures.
• Ability to communicate to people of varied backgrounds in order to obtain data for documentation and verification of information needed in determining eligibility.
• Ability to detect need for other agency services and make appropriate referrals to the service staff.
• Ability to work with facts and figures.
• Ability to perform tasks involving a high degree of accuracy.
• Ability to learn the intricacies of numerous forms and procedures of the eligibility programs.
• Ability to present information orally or in report form.
• Must acquire interest in and understanding of disadvantaged persons, possess qualities of patience and tolerance, and an awareness of various cultures.
• Ability to efficiently and effectively interact with co-workers to accomplish common tasks.
• Ability to have efficient and courteous interaction with all customers.
• Ability to function professionally in occasional highly stressful circumstances.
• Must have the ability to conduct business in an ethical manner at all times.

Required Minimum Education / Experience

• One year of income maintenance casework in Medicaid is required.
• Must have demonstrated the ability to be proficient in and to apply Medicaid policy in the areas of: MA-2270, MA-2275, MA-2280, and SA-5200.