What are the responsibilities and job description for the Annual LOC Reviewer position at South Carolina DDSN?
Job Responsibilities
About Our Agency
- intellectual disability and related disabilities
- autism spectrum disorder
- traumatic brain injury
- spinal cord injury and similar disability
Accurate and timely review of Level of Care (LOC) submissions for individuals currently enrolled in DDSN operated Home and Community Based Waiver programs. Determines acceptable documentation to confirm Agency diagnostic criteria, current supervision needs as well as LOC outcome. Receives clarification or additional documentation as needed from Waiver Case Manager. Works in tandem with Eligibility and/or HASCI Division staff until approval. Responsible for notifying customers of the DDSN Reconsideration and DHHS Appeals process when required. Provides accurate and in-depth guidance to Provider staff in accordance with established DDSN and DHHS Medicaid policy.
Responsible for creation of daily Intellectual Disability/Related Disability (ID-RD) and Community Support (CS) Annual LOC Detail reports to ensure the Eligibility Division remains in compliance with established Medicaid policy and Agency established time-frames. Sends "as needed" alerts to ensure timely submission of requests. Ensures LOC approval within established time-frames. Works directly with the Program Manager, Division staff and Provider staff when problems are identified; takes immediate steps to resolve prior to LOC expiration.
Responsible for creation of daily Nursing Facility Annual LOC Detail reports to ensure the Eligibility Division remains in compliance with established Medicaid policy and Agency established time-frames. Sends "as needed" alerts to ensure timely submission of requests. Ensures LOC approval within established time-frames. Works directly with the Program Manager, Division staff and Provider staff when problems are identified; takes immediate steps to resolve prior to LOC expiration.
Works directly with Providers in regards to identified LOC procedural and training issues as they arise.
Participates as a team member, provides back-up assistance to other Eligibility Division staff; willingly completes other duties as assigned by the Program Manager.
The South Carolina Department of Disabilities and Special Needs offers an exceptional benefits package for FTE positions that includes:
- 15 days annual (vacation) leave accrual per year
- 15 days sick leave per year
- 13 paid holidays
- Paid Parental Leave
- Health, Dental, Vision, Long Term Disability, and Life Insurance
- State Retirement Plan and Deferred Compensation Programs
Minimum and Additional Requirements
A bachelor's degree from an accredited college or university in Health and Human Services or a related field, and at least one (1) year of relevant program or case management experience working with individuals who have been diagnosed with intellectual developmental disorder, conditions related to intellectual disability (related disability), autism spectrum disorder, traumatic brain injury, similar disability and/or spinal cord injury. Knowledge of medical conditions preferred.
Preferred Qualifications
Must possess a strong working knowledge of the Department's defined target population and adequately verbalize understanding of DDSN Eligibility Determination diagnostic criteria as well as rules, regulations and procedures pertaining to the Agency's Level of Care (LOC) review and approval process. Must communicate well and work effectively with others; must demonstrate excellent computer skills. Must demonstrate a high level of detail and accuracy. Must be able to maintain productive working relationships as part of a highly communicative team.
Additional Comments
About Our Agency: The South Carolina Department of Disabilities and Special Needs (DDSN) is the state agency that plans, develops, coordinates, and funds services for South Carolinians with the severe, lifelong disabilities of intellectual disability and related disabilities, autism spectrum disorder, traumatic brain injury, spinal cord injury and similar disability.
EEO Statement: DDSN provides affirmative action and equal opportunity in employment for all qualified persons regardless of race, color, sex -including the basis of pregnancy, childbirth, or related medical conditions, national origin, age, religion, or disability.
Employment Contingency: Employment is contingent upon our receipt of the following required pre-employment screenings: medical screening – to include a drug screening; State and Federal background criminal record checks (to include FBI fingerprinting), SC Dept. of Social Services’ Child Abuse and Neglect Central Registry screening, and CMS “List of Excluded Individuals/Entities” screening; SC Dept. of Motor Vehicles Driving Record check; and a review of transcripts verifying educational credentials. We reserve the right to rescind this offer in the event minimum requirements are not met to include positions that require certifications and/or licensure, your application is incomplete or inaccurate, or our review of your background uncovers information, including opinions of previous employers and references, which cause us to conclude, at our sole discretion, that you are not suited for the position.
Immunization: If this position requires the applicant to work directly with DDSN consumers, a (2) step PPD testing or QuantiFERON TB Gold testing must be completed prior to beginning employment. All new employees who are healthcare providers are required to provide documentation of immunity or be immunized against measles, mumps, rubella, pertussis, Varicella and Hepatitis B prior to beginning employment.
State Disaster Plan: In accordance with the State's Disaster Plan, which includes hazardous weather, DDSN employees may be required to work in times of an emergency or disaster.
Employee Referral: The South Carolina Department of Disabilities and Special Needs supports a Referral Incentive Reward and a Retention Bonus program. You may contact Human Resource for further information.
Supplemental Questions: Supplemental questions are considered part of your official application. Any misrepresentation will result in your disqualification from employment. Please complete the State application to include all current and previous work history and education. A resume may not be accepted nor reviewed to determine if an applicant has met the qualifications for the position.
