Waiver Program Service Coordinator

Role and Responsibilities

Service Coordination provides primary assistance to waiver applicants/participants in gaining access to needed waiver and Medicaid State Plan services, as well as other local, state, and federally funded educational, vocational, social, and medical services. Interventions are expected to result in assuring the waiver participant’s health and welfare and increasing independence, integration, and productivity. The Service Coordinator assists the applicant in becoming a waiver participant and coordinates and monitors the provision of all services in the service plan once the individual is determined eligible. For individuals transferring from nursing facilities, the Service Coordinator assists the applicant in obtaining and coordinating services that are necessary to return to the community. For those individuals residing in the community, the Service Coordinator facilitates the necessary supports to maintain the individual's health and well-being sufficient to avoid unwanted nursing home placement.

A Service Coordinator must be knowledgeable about all waiver services, Medicaid State Plan services, and non-Medicaid services. Informal supports are often a crucial factor if the participant is to live a satisfying life and remain in the community. The Service Coordinator must be skilled in incorporating all of these resources into the waiver participant’s service plan.

Maintain a maximum caseload size of 25 waiver participants.

Essential Functions

• Facilitating the Initial Service Plan (ISP) and waiver program eligibility;
• Coordinating multiple services among multiple providers;
• Securing initial and annual level of care assessments;
• Assuring that Team Meetings are scheduled and held as designated in the service plan, at least every 6-months and provide all waiver providers, participant, and others with written summary of Team meetings and documents accordingly;
• Facilitating the acquisition, oversight, and delivery of service;
• Ensuring annual service plans (Revised Service Plans/RSPs) and required assessments (ex: level of care, LOC) are completed in a timely manner;
• Facilitating the waiver applicant/participant’s Plan of Protective Oversight (PPO) is completed and supports the service plan;
• Conducting monthly face-to-face visits and in-home visits with the participant no less than once a quarter to review the Service Plan (SP), ensure adequate level of satisfaction with services, and ensure progress towards meeting participant’s goals;
• Documenting all visits, contacts and meetings on the required form or within the electronic medical record timely and accurately;
• Maintaining records for at least six (6) years after termination of waiver services;
• Responding to participant crises and emergencies;
• Addressing problems in service provision. Each year the Service Coordinator will develop and submit the Revised Service Plan (RSP);
• Obtaining signed Release of Information and following HIPAA guidelines
• Assuring timely notification of all incidents to the participant, other program or waiver providers and, Regional Resource Development Center (RRDC);
• Ensuring measures are in place for the protection of a participant from harm, injury or abuse and care and treatment is delivered promptly and appropriately
• Coordinating a safe discharge plan for the participant if leaving the NHTD waiver program(s);
• Maintaining knowledge of all approved waiver service providers in assigned region;
• Attending Regional meetings; and
• Other duties as assigned.

This job description reflects management’s assignment of essential functions; and nothing in this herein restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

Qualifications and Requirements

Persons self-employed or employed as Service Coordinators must have one of the following:

• Certified or Licensed Professional in any one of the following:
• Licensed Master Social Worker (Licensed by the NYS Education Department);
• Licensed Clinical Social Worker (Licensed by the NYS Education Department);
• Individual with a Doctorate or Master of Social Work;
• Individual with a Doctorate or Master of Psychology;
• Individual with a Master of Gerontology; Physical Therapist (Licensed by the NYS Education Department);
• Registered Professional Nurse (Licensed by the NYS Education Department);
• Certified Teacher of Students with Disabilities (Certified by the NYS Education Department);
• Certified Rehabilitation Counselor (Certified by the Commission of Rehabilitation Counselor Certification);
• Licensed Speech Pathologist (Licensed by the NYS Education Department); OR
• Occupational Therapist (Licensed by the NYS Education Department).
• A bachelor's degree and one (1) year of experience providing case management/service coordination and information, linkages, and referrals regarding community-based services for individuals with disabilities and/or seniors
• An Associate's degree and two (2) years of experience providing case management/service coordination, information, linkages, and referrals regarding community-based services for individuals with disabilities and/or seniors.

Paid employment and unpaid experience (such as documented volunteer work, internships, etc.) providing case management/service coordination, information, linkages and referrals regarding community-based services for individuals with disabilities and/or seniors can be used to fulfill the requirements for being employed as a Service Coordinator.

Work Environment

• Typing
• Sitting
• Driving

Physical Requirements

• Seeing
• Speaking
• Hearing

EOE/AA Minority / Female / Disability / Veteran