What are the responsibilities and job description for the Case Manager for PCA Program position at Tri-Valley, Inc.?
Overview:
The basic function of the Case Manager/Functional Skills Trainer is to provide the elements of training for participation in the Personal Care Attendant Program relative to the social needs and psychological health of clients.
Responsibilities:
- Be knowledgeable of and comply with all state, federal and agency regulations, policies and procedures pertaining to the PCM program including time frames and Tri-Valley’s agency mission.
- Completes PCA Key Facts sheet for every referral and adds information to the Log Sheet.
- Completes information on physician summary form and faxes to primary care physician for signature.
- Arranges intake visit with consumer and/or surrogate within ten days of receipt of referral.
- Notifies RN and OT when an intake visit has been completed and a RN/OT assessment is needed.
- Completes all required paperwork (MassHealth application, Prior Authorization request and additional documentation) to submit on behalf of the consumer for MassHealth approval. Adhere to program timelines as outlined in the regulations.
- Inputs all consumer information into the PCA software program, and updates this information to reflect any communication or contact with the consumer, their surrogate or any other party.
- Visit the consumer and/or surrogate once the MassHealth approval is received to review the entire program, complete the Service Agreement and Fiscal Intermediary Paperwork.
- Visit the consumer at least quarterly in the first year of approval to review the program and services being provided and more often as needed or requested.
- Visit the consumer as necessary when an increase in hours is requested. Coordinate with the RN to provide an assessment when an increase is being requested.
- Obtain and complete appropriate documentation to submit to MassHealth for any increase in hours.
- Facilitate annual re-evaluation to include coordination with the RN beginning at the third quarterly visit.
- Complete required paperwork for ongoing approval/renewal of PCA services.
- Maintain telephone log of all calls received and returned.
- Attend PCA related events as directed by the Program Manager (quarterly FI meetings, PCA Coalition, etc.)
Qualifications:
- Motor vehicle & Valid Driver’s license; maintain minimum insurance liability on vehicle and complete motor vehicle driving record check.
- Bilingual English/Spanish preferred.
