The LTS Access Coordinator is the initial point of contact for inquiries about Alliance Health related to IDD and TBI services and supports. The Coordinator gathers all documentation of an Intellectual and Developmental Disability and 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 referrals to related services and assistance in linking to community resources, support programs, behavior strategies and navigating the Alliance system for members with primary TBI needs.
This position will allow the successful candidate to work a primarily remote schedule which includes coming into the Alliance Home office (Morrisville, North Carolina) at least one day per week.
TBI Guide provides short-term engagement service to assist individuals with education regarding the TBI Waiver program and related services, ensuring members understand and meet basic TBI Waiver eligibility criteria, and have gathered required eligibility documents, such as medical records and psychological or neuropsychological testing. As needed, TBI Guide will support the individual and family in accessing Medicaid benefits which could facilitate TBI Waiver service access.
ESSENTIAL FUNCTIONS AND DUTIES
REFERRALS AND TRIAGE
Assist providers in understanding the eligibility and referral process and help to coordinate links to referral services.
Shares demand data for both IDD callers and TBI callers with Provider Network to help with network development needs.
Follows up with providers to which referrals are made to ensure that authorization has been secured and that services have begun.
Triaging referrals made to other departments as appropriate for I/DD and TBI inquiries.
Escalate IDD and TBI callers to clinicians within the Access Department for urgent and emergent mental health and/or substance abuse needs.
Communicate appropriate issues needing resolution to LTS Access Coordinator Supervisor. Communicate any changes in service provider options, referral delays or call trends to supervisor.
Enter grievances from callers and work to resolve concerns.
Demonstrates 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.
Assist the MH/SUD Access staff in problem-solving potential IDD and TBI calls.
Assist with residential placement options and processes.
REVIEW AND DOCUMENTATION
Tracks overall demographics, clinical and provider referral information in effort to develop and maintain a dashboard for members seeking access to Care Coordination and Alliance PN for IDD and/or TBI services.
Maintain current resources and provider listings for IDD and TBI services, including knowledge of other state waivers and transition planning.
Reviews and presents supporting documentation to the IDD and TBI eligibility review committee.
Verifies Medicaid eligibility in NCTRACKs for callers
Communicate eligibility review decisions to members/guardians and process appeal requests telephonically and via US Mail
Document calls and case status/outcomes in Jiva.
Upload clinical documentation and correspondence to the Alpha MCS and/or Jiva as needed.
Maintain the Innovations Waiver Waitlist and TBI Registry of Interest, including maintaining Ohio Screening metrics from calls received and larger Access department to anticipate capacity needs for TBI provider network development.
Process diversion exceptions and assist with DC planning for IDD members in EDs or acute stay units.
Coordinate referrals to services and links to non-network community resources for members.
Coordinate care as needed for non-innovations members—facilitate referral to appropriate care coordination team if necessary.
Coordinate cases for NC Start referrals with Complex Integrated Care Coordination Team to promote crisis prevention, treatment coordination and community stabilization.
Assist Dept. of Community Health and Well Being in community meetings, fairs, and presentations to offer information on IDD and TBI services, supports, and processes.
Ability to process cases of dual diagnosed IDD/MH needs and identify need for clinical support. Complete consultations with LTS Access Coordinators Supervisor for medically complex cases, IDD Clinical Director for dually dx cases.
Providing general information to callers and internal staff about I/DD and TBI services, including sending approved educational materials through email or Jiva mailing once member portal is functional.
Listening 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.
MINIMUM REQUIRED EDUCATION AND EXPERIENCE
Graduation from an accredited college or university with a Master’s degree in a human service field and one year of full-time, post-graduate degree accumulated TBI experience; or a bachelor's degree in a human service field and two years of full-time, post-bachelor's degree accumulated TBI experience with the population served; or a graduate of a college or university with a bachelor's degree in a field other than human services and has four years of full-time, post-bachelor's degree TBI experience.
Clinical license preferred. Certification in NACCM, NADD-Specialist, and/or CBIS required within 12 months of hire.
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.