Title: Medical Eligibility Specialist

• 529629

• PHOENIX
• REMOTE OPTIONS

• AHCCCS

• Full-time

• Closing at: Nov 4 2024 at 23:55 MST

The purpose of this position is to determine medical eligibility for customers applying for the Arizona Long Term Care Services (ALTCS) program. Comprehensive Pre-Admission Screenings (PAS) are completed during a face-to-face interview using a designated PAS instrument. Work independently and drive either a state vehicle or their personal vehicle to home and institutional settings to complete interviews and/or obtain documentation. Record actions taken on cases, maintains an electronic case file and updates the Health-e- Arizona Plus. A PAS Assessor may also be required to conduct financial eligibility interviews, complete applications and other forms and obtain verification of eligibility factors to determine the customer's initial and ongoing financial eligibility and share of cost. Some offices require fluency in Navajo.

Major duties and responsibilities include, but are not limited to:
* Drives a state or personal vehicle to conduct comprehensive interactive pre-admission screenings (initial and reassessments) utilizing HEAplus on all age groups in both institutional and community settings. Explains benefits, eligibility requirements and rights and responsibilities to customers.
* Manage and monitor PAS caseload and timeliness, schedule interviews, enter interview notes and score PAS, document follow-up actions with case notes, complete and close PAS assessments within application timeframes utilizing HEAplus.
* Obtains and reviews medical records and other relevant records; gathers data to support eligibility findings; interacts with informants such as family members and caregivers of customers, physicians and other professionals to identify and evaluate medical and psychosocial conditions.
* Interact with other state agencies such as Adult Protective Services (APS), Division of Developmental Disabilities (DDD) and Department of Child Safety (DCS).
* Contact applicants with the outcome of the PAS assessment and provide appropriate community resources for customers determined not eligible.
* Attends staff meetings and participates in exchange of professional information in support of the program. Works on special projects, completes financial eligibility interviews.

Knowledge:
* Medical, functional and psycho-social problems of the elderly, physically disabled and developmentally disabled children and adults.
* Normal and abnormal human development and behavior.
* Appropriate intervention methods for the elderly, physically disabled and developmentally disabled children and adults.
* Medical terminology and procedures.
* Implications of illness or injury on customers and families.
* State and Federal rules concerning long term care, medical services and customer's rights.
* ALTCS policy and procedures.
* Available community resources, crisis intervention, counseling, advocacy, community relationships, and referral methods.
* Cultural, environmental, and community influences on behavior of long-term care populations.
* Functions, major responsibilities and organizational structure of other governmental agencies with whom we interface.
* Adult and child health care delivery systems, the fundamental principles of medical nursing services, alternatives to long term care, length of stay, pharmacology and equipment use.
* Basic math skills.

Skills:
* Effectively prioritizing; analyzing, assessing and evaluating service provisions and quality of care.
* Establishing and maintaining effective working relationships with professional staff, caregivers, customers' families, children and adults and with representatives of courts and various other agencies in the community.
* Communicating effectively, both orally and in writing.
* Reading, understanding and applying rules, regulations and policies.
* Caseload management; schedules, timetables and time management.
* Remaining calm while eliciting information and gaining insights into customers and families, sometimes with irregular situations.
* Working with management and work leadership.
* Evaluating medical and functional conditions and their impact on level of care.
* Using a laptop computer to document information.
* Analyzing and determining propriety of adult and child health care delivery systems.
* Determining the priority of medical and nursing services, selecting care alternatives, interpreting pharmacology and medical terminology and equipment use.
* Researching medical information and codes.

Abilities:
* Be fluent in Navajo (Northern Region Chinle office).
* Read, understand and apply current laws, rules, regulations and policies in making eligibility determinations and in determining share of cost.
* Typing and use of personal computer/laptop and other computer programs for interactive interviewing, review and disposition of cases.
* Make changes and handle changing priorities with little notice.

Arizona Drivers License

Minimum: 3 years of experience providing social service case management that includes individual planning and delivery of health care services; OR Graduation from an accredited school of nursing, with an active Arizona RN license; OR a Bachelors or Master's degree with a major in Social Work, Rehabilitation, Counseling, Education, Sociology, Psychology, Nursing or other closely related field and 2 years of experience providing social service case management. Chinle office only: Bilingual (fluent) in Navajo.

Preferred: Bilingual (Spanish) a plus but not required (All offices other than Chinle).

* Successfully complete the Electronic Employment Eligibility Verification Program (E-Verify), applicable to all newly hired State employees.
* Successfully pass fingerprint background check, prior employment verifications and reference checks; employment is contingent upon completion of the above-mentioned process and the agencys ability to reasonably accommodate any restrictions.
* Travel may be required for State business. Employees who drive on state business must complete any required driver training (see Arizona Administrative Code R2-10-207.12.) AND have an acceptable driving record for the last 39 months including no DUI, suspension or revocations and less than 8 points on your license. If an Out of State Driver License was held within the last 39 months, a copy of your MVR (Motor Vehicle Record) is required prior to driving for State Business. Employees may be required to use their own transportation as well as maintaining valid motor vehicle insurance and current Arizona vehicle registration; however, mileage will be reimbursed.

If this position requires driving or the use of a vehicle as an essential function of the job to conduct State business, then the following requirements apply: Drivers License Requirements.

All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).

Among the many benefits of a career with the State of Arizona, there are:
* 10 paid holidays per year
* Paid Vacation and Sick time off (13 and 12 days per year respectively) - start earning it your 1st day (prorated for part-time employees)
* Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child (pilot program).
* Other Leaves - Bereavement, civic duty, and military.
* A top-ranked retirement program with lifetime pension benefits
* A robust and affordable insurance plan, including medical, dental, life, and disability insurance
* Participation eligibility in the Public Service Loan Forgiveness Program (must meet qualifications)
* RideShare and Public Transit Subsidy
* A variety of learning and career development opportunities

By providing the option of a full-time or part-time remote work schedule, employees enjoy improved work/life balance, report higher job satisfaction, and are more productive. Remote work is a management option and not an employee entitlement or right. An agency may terminate a remote work agreement at its discretion.

Learn more about the Paid Parental Leave pilot program here. For a complete list of benefits provided by The State of Arizona, please visit our benefits page

Lifetime Pension Benefit Program
* Administered through the Arizona State Retirement System (ASRS)
* Defined benefit plan that provides for life-long income upon retirement.
* Required participation for Long-Term Disability (LTD) and ASRS Retirement plan.
* Pre-taxed payroll contributions begin after a 27-week waiting period (prior contributions may waive the waiting period).

Deferred Retirement Compensation Program
* Voluntary participation.
* Program administered through Nationwide.
* Tax-deferred retirement investments through payroll deductions.

Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by emailing careers@azahcccs.gov.
Requests should be made as early as possible to allow time to arrange the accommodation. The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer.