Facilitates and completes the eligibility determination process for AMHH and BPHC. This includes review of all AMHH applications submitted into the electronic data submission portal. This position reviews applications for clinical eligibility, reviews proposed care plans and clinically assesses appropriateness of the proposed services. Detailed eligibility determination protocols and processes must be completed for each application to determine program eligibility, service approval and authorization on a daily basis to timely member access to services and to ensure compliance with federal and state rules and regulations. Approximately 6800 eligibility determinations are completed each year for Adult 1915(i) programs, with approximately 3000 active members/participants at any given time.
- Acts as lead in designated quality assurance activities including but not limited to: Communication to sites prior to, during and post site visits, prepares QA documents for team members, facilitates logistics, complies findings, develops finding and compliance reports, and conducts a minimum of one annual quality assurance site visit with all designated Adult 1915(i) providers and HCBS settings across Indiana.
- Meets regularly with DMHA and OMPP staff, regarding progress and status of the initiatives.
- Reports status of program, development, training, and quality management to Program Director, Deputy Director and consults with others within DMHA staff as needed.
- Investigates and communicates responses to inquiries from providers, members, families, other agencies, and the public regarding Adult 1915(i) and HCBS initiatives.
- Manages and/or directs DMHA staff, OMPP (and its vendors), and CMHCs to assist with eligibility and enrollment of participants and providers as applicable for each program;
- Facilitates and provides training, technical assistance, and coordination of provider visits as required to complete designated activities and tasks;
- Participates in conference calls with Centers for Medicare & Medicaid Services (CMS) and provides all written documentation requested by CMS or OMPP staff that is necessary for quarterly or annual reports, as required and requested.
- Collects, manages, and analyzes data pertaining to programs and initiatives to improve quality, identify trends, and/or present information to our constituents.
- Manages necessary fiscal and program reports needed for state and federal reporting requirements as well as reports needed for internal monitoring and evaluation.
- Participates in development and implementation of provider training, education and forums in preparation for implementation of program changes and updates.
- Coordinates project activities with Deputy Director and Program Director, as well as with staff of other state divisions and departments, stakeholders, providers, and consumers.
- Facilitates training, implementation and compliance activities per program requirements.
- Partners with other State staff, contractors and community partners to collect and analyze data for all Adult 1915(i) programs and HCBS Quality Assurance Plans.
- Works closely with OMPP, OMPP contractors, state staff and community stakeholders to revise program provider manuals, training material, websites, and communication documents annually or as needed.
- Monitors provider’s quality measures progress, outcomes, and implementation of corrective action plans as needed.
- Develops, maintains, and monitors tracking logs and databases to ensure complete and accurate data is entered within the designated timeframes.
- Develops and delivers educational and technical assistance initiatives based up on data analysis, that are intended to increase provider compliance with BPHC/AMHH program requirements and federal HCBS regulatory requirements;
- Facilitates on-going process improvement activities, implementation, and on-going monitoring of CMS HCBS Settings Requirements Final Rule initiatives.
- Performs other duties as assigned.
- Master’s Degree in Social Work, Psychology, or related health field, In addition, must hold current Indiana clinical licensure, such as LCSW, LMHC in a behavioral health field.
- This position requires broad clinical knowledge of mental health and addiction treatment and prevention services for adults with serious mental illness, co-occurring substance use disorders, and/or physical health disorders.
- Must have strong interpersonal relationship skills
- Excellent written and oral communication skills.
- Must possess knowledge of CMS federal and Indiana Medicaid rules and requirements as they relate to the assigned programs and initiatives, to ensure federal and state compliance.
- Must possess knowledge and understanding of CMS federal Home and Community Based Setting (HCBS) regulations, Indiana’s State Transition Plan and the interface necessary for successful implementation of all aspects. This includes but is not limited to: conducting site visits to assess setting compliance with CMS rules; monitoring and tracking Corrective Action Plans, Setting Action Plans, and Member Transition Plans; providing technical support and accountability management to ensure the states’ compliance with the CMS final rule and Indiana State Transition Plan within the designated timeframes,
- Must be able to prepare and deliver information in multiple contexts such as PowerPoint presentations; e-mail; conference calls; in-person or phone verbal conversation; and formal written communication/ letters.
- Must possess and demonstrate ability to utilize application software programs for data storage, data analysis, report writing and transmission.
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