Care Connection/CM Specialist

Description

Job Summary

The Care Connection Specialist/Care Manager, as a member of the Care Connection team, is responsible to help people and families navigate the eligibility, intake and enrollment process to connect to services within the Care Coordination Organization Network, including Health Home Care Management. 

The Care Connection Specialist/Care Manager works extensively with OPWDD Front Door, schools, provider agencies, medical practices and other entities within the community to identify people who need assistance obtaining eligibility and enrollment to Care Management services through CCO Health Home. 

Applies prior experience and knowledge of existing programs to support individuals with developmental disabilities. Establishes relationships with OPWDD Front Door Staff, Local Department of Social Services Staff, and others to assist with outreach efforts. 

This position will need to: 1) understand the goals of Care Coordination and the needed support services (e.g., health care, education, work opportunities, residential programs, vocational and recreational activities) for individuals/families served; 2) develop a strategy to effectively grow our membership by understanding local needs and prioritizing leads; 3) support enrollment efforts and membership growth goals. 

1. The Care Connection Specialist/Care Manager is responsible for assisting the person/family/advocate with the formal CCO intake and enrollment process. The Care Connection Specialist/Care Manager is responsible for informing the individual/family about Health Home Care Management, as well as HCBS Basic Plan support, and assisting them in making an informed choice. 

2. Reviews criteria for OPWDD eligibility with the person, and / or family member/advocate. 

3. Assists family with navigating OPWDD eligibility application process, and LCED application process. Assist in acquiring documents to support these processes and send completed forms/packet to OPWDD for approval. 

4. Acts as liaison between various entities during intake process and thereafter; 

5. Assists with Medicaid application, if the person does not already have Medicaid. Attending the Medicaid appointment with the person / family / advocate may be required. 

6. Reviews and Completes Health Home / CCO DOH enrollment forms with person/family. Completes HH CCO program enrollment within the OPWDD CHOICES system. 

7. Updates and maintains Intake Database, including tracking of required documents such as but not limited to; Eligibility, LCED, Letter of Introduction, (if applicable) Medicaid, DOH HH Consent forms. 

8. Prepares and maintains any relevant documents to ensure all required intake documentation is complete. This includes collecting all relevant assessments from service providers and ensures consumer choice is maximized. 

9. Provides community outreach to connect with those individuals who are not served, including areas that are under-served. 

10. Assists Care Management department as necessary in providing overall caseload coverage, and in transitioning individuals from intake to active care coordination roster. Provide short-term care management if needed, 

11. Complies with OPWDD and DOH regulations pertinent to Care Coordination. Completes all necessary paperwork as outlined by procedures manual. 

12. Maintains all relevant documents in Person’s record, including all phone contacts, correspondence, assessments, and reports. 

13. Ensures all confidential records are secured and initiate enrollment to LIFEPlan CCO. Utilize OPWDD CHOICES system, and M-Files. 

14. Reports to supervisor and/ Care Connection management team the status of intakes; including but not limited to # of people eligible both with and without Medicaid. 

15. Establishes and maintains a community network between service providers internal and external to the Agency. 

16. Attends all required training in accordance with Agency and Departmental policies and procedures. 

17. Attends and actively participates in departmental meetings. 

18. Serves as a mandated reporter by reporting incidences of abuse, neglect, and maltreatment, and follows LIFEPlan OPWDD untoward incident reporting procedures. 

19. Adheres to standard safety practices of job, department, and Agency policies and procedures related to safety. 

20. All other tasks as deemed appropriate by Supervisor. 

Outreach Initiatives: 

• Apply existing materials or develop new materials as needed including written and electronic materials to meet the needs of the specific target population, provider, or service 

• Provide thorough, professional presentations to the appropriate parties – including, but not limited to: 

• Provide insight into LIFEPlan, the CCO model, the I/DD community, and its competitive service advantage for members and providers 

Qualifications

A. Education: 

• Associated degree if grandfathered in per OPWDD regulations. 

• Bachelor’s degree in field of Human Services or related field 

• Graduate degree (Masters) preferred. 

• Specialized training, license, certification, skills in: MSC, DOH and/or OPWDD programs and funding, Health Home Care Coordination 

B. Experience: 

• At least 3 to 5 years of job-related experience, specifically in working with people with intellectual or developmental disabilities. 

• Related experience, specifically as a Medicaid Service Coordination or Care Manager is preferred 

• Must be able to take initiative and see a project through to completion. 

• Project management skills appropriate to manage multiple initiatives at one time. 

• Minimum intermediate-level Microsoft Office skills 

Salary : $27 - $28