YOUR EXPERIENCE COUNTS - Under a recent change to the rules, an applicant's relevant experience now counts towards formal education degrees referenced in the posting See Per 405.1.

18 Months of additional relevant experience = Associate's degree

36 Months of additional relevant experience = Bachelor's degree

54 Months of additional relevant experience = Master's degree

Conducts medical eligibility determinations and reviews for Medicaid categorical disability programs and authorizes waiver eligibility for the Home and Community Based Care waivers in accordance with Federal, State and Medicaid regulations.

RESPONSIBILITIES:

Applies knowledge, judgment and skills in assessing and evaluating the needs of individual applicants to determine eligibility and level of care through a review of medical & functional data including but not limited to, medical reports, exams, psycho-social evaluations, clinical data, occupational and vocational information.

Performs reviews, at least annually, to determine continuing eligibility and level of care for identified Medicaid programs. Reviews, evaluates, monitors and supervises the effectiveness of case management services provided by contracted agencies and staff.

Analyzes, authorizes, records and approves Medical eligibility requests for home, specialized medical equipment and environmental modifications. Supporting documentation is documented in multiple systems including New Heights, NHEASY, Options, Budget Tracking System (BTS), NH Leads, and Medicaid Management Information Systems (MMIS).

Provides assurances and program integrity using all eligibility determination instruments such as the Supports Intensity Scale (SIS); Health Risk Screening Tool (HRST); Functional Screen; and, Scales of Independent Behavior – Revised (SIB-R).

Reviews assessments of all applicants who do not meet medical eligibility criteria and skillfully assesses additional medical, surgical and or diagnostic information provided by the applicant in support of his or her need for therapeutic/medical long-term care (LTC) services. Prepares case documentation and the development of testimony as required in preparation for Administrative Appeals hearings in long term care cases.

Expedites medical record collection process when necessary by contacting area agencies and/or health care providers directly via phone, email or fax on behalf of applicants, recommends additional evaluations when further information is needed to support waiver eligibility.

In consultation with, and as designated by Management, participates in the training, supervision and evaluation of subordinate staff and contracted consultants assigned to determine eligibility.

Works with management to identify changes to policies, procedures and informational tools that will enhance productivity and improve operational effectiveness. Participates in continuous quality improvement workgroups convened to address areas requiring improvement.

Assists, when requested, with the Bureau of Elderly and Adult Services eligibility.

MINIMUM QUALIFICATIONS:

Education: Master's degree from a recognized college or university with major study in human services, business or health care administration, or a related field. Each additional year of approved formal education may be substituted for one year of required work experience.

Experience: Four years' professional experience in human services, business or healthcare administration or a related field, with responsibilities in program research, planning, monitoring, and evaluation.

OR

Education: Bachelor's degree from a recognized college or university with major study in human services, business or healthcare administration, or a related field.

Experience : Five years' professional experience in human services, business or healthcare administration or a related field, with responsibilities in program research, planning, monitoring, and evaluation. Each additional year of approved work experience may be substituted for one year of required formal education.

License/Certification : Valid driver's license, if necessary for travel throughout the state.

PREFERRED QUALIFICATIONS: Experience in developmental services.

PREFERRED WORK TRAITS: Knowledge of federal and state public assistance laws and requirements regarding recipients. Knowledge of medical, surgical, diagnostic, scientific and therapeutic procedures provided in home and community based service settings, hospitals, skilled nursing homes and other medical care providers. Skill in appraising health care problems, procedures and programs. Knowledge of the developmental services system. Ability to plan, supervise, coordinate and direct the work of others. Ability to prepare factual reports. Ability to communicate effectively. Ability to coordinate the work of state, private agencies, and contracted area agencies in the health care area. Ability to establish and maintain effective working relationships with other employees and the public.

DISCLAIMER STATEMENT: The supplemental job description lists the essential functions of the position and is not intended to include every job duty and responsibility specific to the position. An employee may be required to perform other related duties not listed on the supplemental job description provided that such duties are characteristic of that classification.