Senior and Disability Services - Case Manager

SUMMARY OF POSITION: 

This position is FLSA non-exempt and eligible for overtime. This position is union represented. Provides initial service eligibility and ongoing case management with financial eligibility coordination to individuals needing personal care assistance to promote quality of life, independence, and care in the least restrictive setting. Works with Medicaid payment/ tracking systems, Consumer Assessment and Planning Systems (CAPS), as well as related forms and terminal screens. 

Performs position duties in a manner which promotes customer service and harmonious working relationships, including treating all persons courteously and respectfully.  Engages in effective team participation through willingness to assist and support co-workers, supervisors, and other work-related partners.  Develops good working relationships with division and agency staff and supervisors through active participation in accomplishing group projects as well as identifying and resolving problems in a constructive manner.  Demonstrates positive acceptance of constructive feedback and suggestions to strengthen work performance.  Contributes to a positive, respectful, and productive work atmosphere.  Regular attendance is required to meet the demands of this job in order to provide necessary services. This position is a Mandatory Reporter by statutory requirement. 

ESSENTIAL JOB DUTIES: 

Essential Duty 1:  Waivered Case Management: 40%

• Conducts initial, annual, and ongoing risk assessments and risk mitigation reviews.  
• Monitors ongoing cases, adjusting service plans as needed.   
• Provides backup support to other social workers and unit staff as directed by supervisor, including protective services. 
• Provides relocation planning for nursing facility clients and/or clients requesting transfer to other living situations. 
• Assists consumers in requesting and obtaining K-State Plan Ancillary Services and/or Special Needs eligibility.  
• Provides crises response and intervention to support consumers care needs and care plan. 
• Makes referrals to community resources to support individual care plans.  
• Assists consumers through service provision issues and problem solving to resolve issues with providers, services, and/or hours that do not meet the individual’s needs.  

Essential Duty 2:  Service Assessments: 35% 

• Completes initial service assessment eligibility and ongoing annual service reviews in accordance with Oregon Administrative Rules (OARs).  
• Interviews consumers in their own home or care setting to gather personal, social, and medical history information in order to determine and assess person-centered needs, current level of functioning, eligibility,
• preferences, and the need for appropriate referrals. 
• Conducts assessment of medical/psycho/social needs for persons needing home and community- based services.   
• Completes Consumer Assessment & Planning System document and/or State Plan Personal Care Assessment.  
• Determines if services are to be provided by Medicaid.  If assigned, completes service eligibility in full, including all necessary paperwork and updating affiliated systems.  May refer to the Oregon Project
• Independence (OPI) Case Manager and/or other community service options. 
• Reviews and assists consumers with requesting and monitoring Extended Waivered Eligibility.  

Essential Duty 3:  Service Planning: 15% 

• Develops service plan to meet service and care needs.  Coordinates with hospitals, other health care providers, family, friends, and significant others to ensure comprehensive needs are met, including assisting consumers and/or providers through exceptions processes.   
• Establishes specific care plans including hours and specifics of home care and personal care services. Arranges for contractor or consumer-employed provider to provide services for consumer.   
• Arranges for Long-term Care Community Nurse (LTCCN) or individual consumer employed contract RN to assess for personal care plans.  May complete all paperwork associated with payment authorization process and routes through established office procedures. 
• Arranges for Behavioral Support Services and Emergency Response Services to support care planning.  May complete all paperwork associated with payment authorization process and routes through established office procedures.  
• Monitors ongoing cases and adjusts service plans as needed.  Arranges for necessary services such as home delivered meals, transportation, and prior authorized medical. 
• Provides resource referral for family caregivers. 
• Updates all affiliated service planning systems and ensures all service plan forms are issued to consumer and returned per policy standards.  

Essential Duty 4: Provider Billing/ Payment Resolution: 5% 

• For in-home and community-based care and/or nursing facility consumers, provides all related information and paperwork regarding rates and other expectations to providers, consumers, and responsible family members or representatives.   
• Completes all paperwork associated with payment authorization process and routes through established office procedures, and ensures these individuals are provided with all necessary forms. 

• Troubleshoots payment issues for resolution and monitors payment systems for accuracy and timely payment. 
• Directs provider questions to appropriate resources when necessary.   

Essential Duty 5: Maintain Consumer files: 5% 

• Completes all paperwork associated with long term services and supports Medicaid programs. 

• Updates consumer file systems in accordance with policy standards and assists in forwarding forms to appropriate file retention records as required.   

OTHER JOB DUTIES: 

• Attends unit meetings, staffing and training as directed by supervisor. 
• Performs other related duties as assigned by supervisor. 

• Assists in Oregon Administrative Hearings requests. 
• Participates with internal and external quality assurance audits and reviews. 
• Provides team members with assistance with case management questions and concerns.   
• Performs and follows mandatory reporting requirements.  

SUPERVISION RECEIVED:  Receives general supervision from the Senior and Disability Services Program Supervisor. 

SUPERVISORY RESPONSIBILITIES:  None 

WORKING ENVIRONMENT: 

Work is performed primarily in an office environment utilizing a personal computer, laptop, telephone, and a variety of office equipment.  Frequent travel to consumers’ homes and other health care facilities is required.  Field work requires transportation and utilizing laptop computer. May risk exposure to people with irrational/hostile behavior and/or contagious diseases.  May risk contact with domestic animals while making consumer visits.  Occasional travel to various meetings and trainings is also required. 

MINIMUM QUALIFICATIONS: 

Experience & Training: 

Staff working for the Department or the Department's designee must meet the following requirements to provide case management services:

• A bachelor’s degree in a behavioral science, social science, or a closely related field; or
• A bachelor’s degree in any field and one year of human services related experience that may include providing assistance to people and groups with issues such as economical disadvantages, employment barriers and shortages, abuse and neglect, substance abuse, aging, disabilities, prevention, health, cultural competencies, or inadequate housing; or
• An associate’s degree in a behavioral science, social science, or a closely related field and two years of human services related experience that may include providing assistance to people and groups with issues such as economical disadvantages, employment barriers and shortages, abuse and neglect, substance abuse, aging, disabilities, prevention, health, cultural competencies, or inadequate housing; or
• Three years of human services related experience that may include providing assistance to people and groups with issues such as economical disadvantages, employment barriers and shortages, abuse and neglect, substance abuse, aging, disabilities, prevention, health, cultural competencies, or inadequate housing.

 Knowledge, Skills, and Abilities: 

• Knowledge of the elderly and/or people with disabilities, and familiarity with the problems and issues confronting the elderly and/or people with disabilities in the local community. 
• Knowledge of community resources. 
• Knowledge of confidentiality rules regarding consumer and provider records and investigations, including HIPAA regulations. 
• Knowledge of, and ability to operate, a personal computer. 
• Knowledge of, and experience in, Microsoft software. 
• Ability to effectively communicate orally and in writing. 
• Ability to assess individuals in their own home to determine appropriate service and/or community referral. 
• Ability to work effectively with representatives of other social agencies and members of the public. 
• Ability to work effectively with consumers and to use good judgment in handling individual case problems. 
• Ability to interact and work with a culturally diverse population. 
• Ability to exercise good time management skills to accomplish both daily tasks and on-going projects. 
• Ability to maintain accurate, up-to-date records and to prepare accurate reports. 
• Ability to work independently, organize and structure tasks, handle multiple projects and a high volume of work. 
• Ability to initiate own work with minimum supervision. 
• Ability to establish and maintain positive and effective working relationships with staff, consumers, other agencies, and the general public. 
• Skills in performing psychosocial assessments. 

Licenses, Certificates, & Other Requirements: 

• Possession of a Valid Oregon Driver's license and the ability to travel over a tri-county area. 

• Position requires successful completion of a criminal history and driving record check. 

This job description in no way states or implies that these are the only duties to be performed by an    employee occupying this position.  Employees are required to follow any other job-related instructions and to perform any other job-related duties requested by their supervisor. 

Requirements are representative of minimum levels of knowledge, skills, and abilities.  To successfully perform this job, the employee will possess the abilities or aptitudes to perform each duty proficiently.