Waiver Services Specialist
Agency Name: Community Living Services
Agency Contact: Diana Kaszyca
- Position Type: Full Time
- Job Type: Permanent
- County: Wayne
- Salary Range: $38,697, - $52,240 per Year
- Send applications to: firstname.lastname@example.org
- Please include your resume when applying.
Job Summary: The Waiver Services Specialist is responsible for the enrollment, tracking, and maintenance of Waiver certifications and re-certifications for Waiver enrollees who are supported by Community Living Services. The Specialist must have knowledge of waiver services offered in Michigan such as the Habilitation Supports Waiver (HSW) Program, Children’s Waiver, Autism Waiver, and any other Waiver programs that become available. The Specialist provides both direct services and the coordination and oversight needed to assure Waiver certifications are current, signed, and authorized consistent with the person’s Individual Plan of Service (IPOS). They will track and verify individual enrollment status via the state database, and assist with completing the recertifications process before expiration of the current certification. This position will serve as our CLS liaison and representative for all Waiver benefit plans.
Reporting Relationship: Supports Coordination Director
• Work with our funders and our Support Coordinators to identify people potentially eligible for the HAB Waiver and assist with assembling documentation and gathering qualifying materials to complete the initial Waiver packet.
• Complete the Waiver packet review process to assure the standards are met, and submit the packets for approval via the state Waiver Program portal.
• Provide training and guidance to Support Coordinators and other stakeholders on the benefits of Waiver services, and the requirements and standards for new and continued enrollment.
• Track Waiver certification and Waiver consent expiration dates and develop Waiver packets at least two months prior to the due date of the Waiver (to allow ample processing and approval time).
• Check the WSA daily for any pended back packets, and directly follow up on any needs identified.
• Comply with waiver processing protocols established by our funders at the county and state level.
• Ensure individuals receive at least one Habilitation Supports Waiver (HSW) service per month by tracking for this, and following up with SC Management if monthly service provision is not consistently documented in the file.
• Ensure the non-duplication of habilitation services by other program providers.
• Review submitted documentation to ensure medical necessity criteria including the amount, duration, and scope of services and supports identified are present in the Individual Plan of Service (IPOS).
• Review submitted documentation to ensure Goals. Objectives, and Interventions are documented according to county and state expectations.
• Update Waiver Supports Application (WSA) State database with HSW recertifications, HSW recertification consents (uploaded every 3 years in the demographics tab), the Major Life Activity scoring under the level of care tab, the habilitation goal, and documentation of which HSW services that the individual is receiving.
• Monitor all hospitalizations and rehabilitation stays of the individuals for “Inactive” status adjustments. Update WSA State database with admission and discharge information. This includes any terminations, if the individual no longer meets one or more of the eligibility criteria or voluntarily withdraws from the Waiver program.
• Maintain the occupancy status in ARROW with regards to moves, hospitalizations, discharges, and deaths.
• Enter enrollee insurance policy data in ARROW including, but not limited to Waiver, Autism, and MI Choice.
• Enter and maintain documentation related to waiver applications/certifications and upload into the enrollees’ charts in ARROW under Habilitative Supports (HAB) Waiver Certifications and Insurance Policies/Funding Source/HAB Waiver Tracking.
• Work in coordination with the assigned Benefits Technician to assure all individuals on various Waivers have Medicaid eligibility.
• Maintain a tracking system to monitor and assure follow up on all Waiver reports, applications, certifications, reapplication, and recertification due dates.
• Monitor WSA site daily for tracking of pending application status.
• Coordinate any moves out of county to assure transition of Waiver status properly occurs.
• Receive referrals from individuals supported by CLS, support coordinators or guardians needing assistance related to their needs for Waiver Services.
• Make direct contact with person served and their legal representatives to follow up on Waiver enrollment and re-certification needs. This contact is expected to be both phone and face-to-face as needed and can be for tasks such as completing the Major Life Activity Assessment, getting consents or plan documents signed, and updating IPOS content to be in line with Waiver standards and expectations. Direct contacts would also include linking, coordinating, and monitoring of the person’s Waiver needs.
• Enter IPOS Addendum and Goals, Objectives, and Interventions per agency guidelines (Goals should be in the person’s words, whenever possible. Objectives should be measurable and follow SMART criteria, and Interventions need to outline the steps taken including detailing the amount, scope, duration, and frequency of any services authorized).
• Provide ongoing status updates to the person and document in the Progress notes.
• Complete Addendums and Progress Notes within 48 hours of service provision to reflect the progress being made. Document functions performed, and actions taken to address barriers or challenges and noting the person’s level of satisfaction with the services provided.
• Communicate with DWIHN on a regular basis with status updates.
• Represent CLS on Waiver services workgroups.
• Attend all trainings and informational/update sessions regarding Habilitation Support Waiver (HSW), Children’s Waiver Program (CWP), MI Choice Waiver, Autism, and any other waivers services as they become available.
• Serve as our Waiver liaison to funders, provider network, stakeholders, and guardians in communicating required and pertinent information relative to various Waiver services and requests.
• Assist with the preparation and follow up related to all Waiver audits conducted by funders or accrediting agencies.
• Participate in agency work groups and special projects.
• Be our internal subject matter expert on Waiver regulations and the criteria outlined in Medicaid Provider Manual.
• Provide education and attend meetings with internal and external stakeholders to present new and/or changes in procedures, benefits coordination, and/or related topics.
• Prepare documentation, summaries and other departmental reports as required.
• Provide other assistance and supports as requested.
Qualifications and Requirements:
Education and Experience:
Minimum of a Bachelor’s Degree in a Human Service field with a current license as a Licensed Bachelor’s Social Worker (LBSW) with the State of Michigan and credentialing as a Qualified Intellectual Disabilities Professional (QIDP). At least one year of experience providing Waiver services to people with intellectual and developmental disabilities.
Special Knowledge/ Skills:
Ability to communicate effectively and establish positive collaborative relationships. Must be a highly conscientious and organized person, with independent work skills. Excellent computer skills required, including knowledge of and proficiency with word processing, spreadsheets, email and various databased. Experience with PCE systems, such as ARROW, ODIN, and MHWIN preferred. Ability to develop proficiency in the use of state portals and databases. Demonstrated experience with system development and tracking/monitoring systems preferred.
On the job training provided. Must complete mandatory training requirements on an annual basis.
Periodic scheduled and non-scheduled travel required in executing essential duties and responsibilities of this position. Employees must provide their own transportation. Maintenance of a valid driver’s license, an acceptable driving record, and vehicle registration and insurance in compliance with State of Michigan requirements are all continuing conditions of employment. If driving a vehicle other than the one listed on file with the Human Resources Department, employee is responsible for ensuring the vehicle is registered, insured, and meets all other State of Michigan motor vehicle requirements and providing documentation as requested.
CLS policy restricts the use of an alternate driver without the express, prior written authorization of the Human Resources Director. A review of such request will be based on evaluation of HIPAA compliance issues, work restrictions and other relevant factors.