JOB SUMMARY

The LTS Access Coordinator is the main point of contact for inquiries about Alliance Health related to eligibility for IDD and TBI services and supports. The LTS Access Coordinator gathers all documentation of an Intellectual and Developmental Disability and/or TBI, educates callers about services available through Alliance and its network, assesses needs based on eligibility criteria for services to which callers could be potentially referred services and explains the waiting list process for needed services, including Innovations and TBI Waivers. LTS Access is the entry point for eligibility reviews and Innovations and TBI Waiver waitlists and enrollment.

This position is full-time remote. Selected candidate must reside in North Carolina. Occasional travel for onsite meetings at the home office (Morrisville, North Carolina) may be required.

ESSENTIAL FUNCTIONS AND DUTIES

LTS ELIGIBILITY REFERRALS

Receive referrals and inquiries from internal stakeholders, individuals, families, and providers regarding eligibility for I/DD and TBI Supports Assist individuals, families, and providers in understanding the eligibility and referral process Assist individuals and familied interested in TBI or IDD services to establish eligibility for services and the Innovations and TBI Waiver lists Provide information about the Waivers and eligibility as well as resources for individuals not enrolled in services Review available documentation for eligibility determination Support members in gathering needed documentation to determine eligibility for TBI and I/DD services Determine eligibility for members whose documentations directly supports criteria for the population eligibility requirements Review and presents supporting documentation to the IDD and TBI eligibility review committee as needed Refer reviews to the medical team for members whose eligibility is complex or unclear Inform members of the outcome of the eligibility review process, including providing waitlist date or adverse decision letters and resources both telephonically and via US Mail Communicate appropriate issues needing resolution to LTS Access Coordinator Supervisor Enter grievances from callers and work to resolve concerns Demonstrate understanding of UM due process, appeals regulation, various insurance limits and coverage relating to IDD and TBI services and fields questions and provides support to callers

WAITLIST MANAGEMENT AND WAIVER ENROLLMENT

Maintain the Registry of Unmet Needs for the Innovations Waiver and the Registry of Interest for the NC TBI Waiver Maintain the Innovations Waiver Waitlist and TBI Registry of Interest, including updating information about members to support Alliance reporting Complete contact with individuals on the Registry of Unmet Needs who are not eligible for Care Management Assist individuals that move to transfer their RUN information to or from another PIHP Inform individuals when they are able to enroll in either the Innovations or TBI Waiver as identified for attrition (rollover) slots or reserve capacity CAP/C Age Out, Military Transfer, or Emergency Reserve slots Provide information and education about the waiver enrollment process Support individuals and their families to obtain documentation to support waiver enrollment Review documentation for completeness and provides supporting documents and level of care to external and internal reviewers to enroll in the Innovations or TBI Waivers Inform individuals of Waiver Level of Care decisions including sending adverse decision letters via US Mail Inform internal or external care management providers of approved Level of Care decisions for waiver enrollment Support members without care managers to make Emergency Reserve Waiver slot requests Assist individuals and families to gather supporting information for Emergency Reserve slot requests Inform members of decisions made regarding Emergency Reserve requests, including sending award letters or adverse decision letters

REVIEW AND DOCUMENTATION

Complete enrollment in the electronic record systems for individuals not already included as needed Maintain current resources and provider listings for IDD and TBI services, including knowledge of other state waivers and transition planning Verify Medicaid eligibility in NCTRACKs for callers Document calls and case status/outcomes in Jiva and ensure clinical documentation (e.g. progress notes, documents, etc.) meets state, agency documentation standards, and Medicaid requirements Upload clinical documentation and correspondence to the ACS and/or Jiva per Alliance documentation standards

CARE COORDINATION

Provide information about services and non-network community resources for members Facilitate referral to appropriate care management team if necessary Complete referrals to specialty programs that require eligibility confirmation (e.g. NC-START, Community Connections) Assist Department of Community Health and Well Being in community meetings, fairs, and presentations to offer information on IDD and TBI services, supports, and processes as needed Ability to recognize individuals with dually diagnosed IDD/MH needs, medical complexity, or emergent needs and identify need for clinical support

CUSTOMER SERVICE

Provide general information to callers and internal staff about I/DD and TBI eligibility, including sending approved educational materials through email or Jiva mailing once member portal is functional Listen to parents, guardians, and individuals with I/DD and TBI about concerns and questions and problem solves with same to address and resolve related issues and barriers to care Promote customer satisfaction through ongoing communication and timely follow-up on any concerns/issues Assist families moving to NC or the local area to understand available supports and potential changes in services Maintain positive community relationships and promote the sharing of resource information

COMPLIANCE WITH ALLIANCE POLICIES AND PROCEDURES

Adhere to all Alliance Organizational Policies and Procedures and Care Management Desk Procedures

MINIMUM REQUIRED EDUCATION AND EXPERIENCE

Bachelor's degree from an accredited college or university in a human service field and two (2) years of full-time, post-bachelor's degree accumulated I/DD experience with the population served; 

Or 

Bachelor’s degree from an accredited college or university in a field other than human services and four (4) years of full-time, post-bachelor's degree I/DD experience

Or 

Master’s degree from an accredited college or university in a human service field and one (1) year of full-time, post-graduate degree accumulated Intellectual/Developmental Disabilities (I/DD) experience

Preferred: Clinical license preferred. Certification in NACCM, NADD-Specialist, and/or CBIS preferred  

KNOWLEDGE, SKILLS, AND ABILITIES

A thorough knowledge of diagnostic assessment principles of developmental disabilities and TBI is required. Ability to evaluate and screen clients for appropriate treatment, as well as accurately document the process. Proficiency in crisis intervention principles and techniques are essential in the work. Ability to maintain effective working relationships with consumers, families, peers, supervisors, service providers and representatives of community agencies is another requirement of this position. Excellent verbal and written communication skills are essential. Must be able to communicate effectively with individuals/families supported and their families, service providers, community agencies, MCO employees and a variety of other community members. Employee must always provide a positive image of the agency. A demonstrated knowledge of intellectual and developmental disabilities and traumatic brain injury is a necessity. Having basic understanding of Innovations and TBI Waivers, Medicaid B3 services and state funded services; knowledge of crisis protocols for IDD and TBI individuals with challenging behaviors. Additionally, the incumbent should be able to apply this knowledge in problem-solving and responding to questions/inquiries. This position requires exceptional interpersonal skills, highly effective communication ability, and the propensity to make prompt independent decisions based upon relevant facts and established processes. Problem solving, negotiation and conflict resolution skills are essential to balance the needs of both internal and external customers.

Salary Range

$28.96 - $37.65/Hourly 

Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity. 

An excellent fringe benefit package accompanies the salary, which includes:    

Medical, Dental, Vision, Life, Long Term Disability Generous retirement savings plan Flexible work schedules including hybrid/remote options Paid time off including vacation, sick leave, holiday, management leave Dress flexibility