Eligibility Specialist

POSITION SUMMARY :

Join VHO and make a difference! VHO provides program management for the Nexus Program, a growing program funded through HHS / HRSA, that expands the population of People Living with HIV ( PLWH) served in clinics to private infectious disease practices in Northern Virginia (N OVA). The Nexus Program Eligibility Specialist role must adhere to Ryan White Virginia Part B and DC HAHSTA’s Part A Non-Medical Case Management Service Standards.

The Eligibility Specialist is an entry level position. The Eligibility Specialist conducts the initial eligibility assessment of clients in our grant funded program for medication assistance and other care and support services to promote and support self-reliance and improve individual navigation of health and human service support systems. The assessment includes obtaining the required documentation for the eligibility enrollment application including proof of income, verification of residency, and ID. The enrollment application is completed and shared with the Non-Medical Case Manager.

Eligibility Specialists refer only those eligible clients to Non-Medical Case Management for further guidance and assistance in accessing medical, social, community, legal, financial, and other needed services.

Eligibility Specialist Services may also include benefits counseling and referrals in obtaining access to other public and private programs for which they may be eligible, such as Medicaid, Medicare Part D, other state or local health care and supportive services, and health insurance plans through health insurance Marketplaces / Exchanges. This service category includes several methods of communication including face-to-face, phone contact, and any other forms of communication deemed appropriate by the recipient.

Key activities include :

A.    Initial assessment of eligibility, and appropriate referrals

B.    Complete required enrollment application with client

C.     Eligibility verification at least every 6 months with documentation updates as necessary

D.    24 month eligibility renewals for all clients

E.     Update progress notes documentation and recording of services in the client paper chart / EHR, on the required forms and in the required CAREWare Ryan White database.

F.     In addition to the above documentation requirements, the Eligibility Specialist will provide monthly timesheets by the 2

business day of the following month that tracks day to day activities required by the position

G.    The Eligibility Specialist will participate in the Quality Management and Quality Improvement projects for the Nexus Program.

H.    The Eligibility Specialist will participate in monthly Nexus Program Case Management meetings, the annual VDH Case Management Summit, and DC HAHSTA’s hosted Case Management Meetings. Currently these are conducted via Zoom.

Minimum education and ongoing training requirements for Eligibility Specialist

1.     Associate’s / bachelor’s degree in health or human services related field preferred. High School diploma or GED required .

2.     Bilingual in Spanish required

3.     A minimum of 1 year of experience working with persons living with HIV or at high risk of HIV acquisition preferred.

4.     Ongoing education / training in HIV-related subjects required

5.     VHO will provide new hires with training regarding confidentiality, client rights and the agency’s grievance procedure

6.     Must be detailed oriented and able to follow required processes and procedures required

Eligibility Specialists must complete a minimum training regimen within one year of hire date that includes :

1.     ADAP requirements and application

2.     Overview of Medicaid, Medicare, SSI, SSDI

3.     Non-Medical Case Management Service Standards

4.     National Standards for Culturally and Linguistically Appropriate Services (CLAS)

5.     Ryan White eligibility criteria.

6.     Trauma-Informed Care

If newly hired, Eligibility Specialist that have previously obtained all the required training, will not need to repeat it. Documentation of completion of required training must be kept in the Eligibility Specialist’s personnel file.

Sixteen (16) hours of training / education in HIV / AIDS is required annually. Ongoing training on changes to benefit program and their eligibility, such as Medicare, Medicaid, SSI, SSDI, Ryan White, etc., is also required annually. Documentation of completion of required training must be kept in the Eligibility Specialist’s personnel file.