Financial Representative 2- Novice (705930)

JOB DESCRIPTION, DUTIES AND RESPONSIBILITIES:

The incumbent will be assigned to the Division of Participant Supports, Case Management Unit (CMU) and will be tasked (1) to provide effective case management of the UPMC CHC MCO complaints received on the Office of Long Term Living’s (OLTL) Participant Helpline or other sources and track for resolution; (2) to assist the Subject Matter Expert on the CMU team with Operational Reports.

• Manage a caseload of participants served by CHC UPMC Managed Care and ensure resolution/closure of these complaints.
• Management of the CHC UPMC Managed Care caseload requires daily review of reports and timely follow up regarding these calls.        
• Lead for presenting CHC UPMC Managed Care caseload participant stats from the OLTL Participant Helpline during the monthly calls.
• Lead for management of CHC UPMC Managed Care caseload that includes legislative inquiries.  This requires reports submitted to the Office of Legislative Affairs office on a weekly basis.
• Responsible for back up for other CHC Managed Care daily reports and urgent complaints.
• Responsible to assist Subject Matter Expert for CHC Operational Reports.  
• Respond orally and in writing to basic inquiries within a reasonable timeframe regarding home and community-based programs.  Prepare responses to legislative inquiries for review by supervisor.        Investigate complaints received from participant, service coordinator or supervisor and provide resolution, seeking supervision when necessary.  
• Use established precedent and policy to provide guidance, consultation, technical assistance, to enrollment brokers, service coordinators applicants and caregivers; advise supervisor of problems and/or unusual issues as appropriate.
• Identify any operational issues which impede the provision of appropriate, cost-efficient services to individuals and recommend remedies/necessary changes to supervisor.  As a member of a Team or Division group, participate in developing/revising OLTL home and community-based program policies and procedures.
• Prepare detailed analysis and summary of current issues, service plan trends, or other statistical data both to support projects as well as on-going management of the program.
• Participate in developing and presenting training to Division staff, other OLTL staff, key constituents, and providers.
• Serve on workgroups comprised of staff from within OLTL or stakeholders from outside OLTL.  Committee work may include preparing Medicaid waiver amendments and renewals; evaluating policy recommendations, directives, and regulations; and assisting with the development of operational manuals, program directives, work plans, system changes, regulations, training and policies and procedures to ensure that home and community-based waiver and community programs are administered accurately, effectively, and efficiently and that services meet participant needs.
• Draft responses to programmatic reviews of service provider agencies conducted by staff from other bureaus, or reviews by federal oversight agencies such as Centers for Medicare and Medicaid Services (CMS).  Work may include the development of written work plans to remediate findings in such reviews.  
• Attend and participate in team meetings, division, and bureau meetings as scheduled.  
• Participate in hearings as requested by the DPW Hearings and Appeals Office.
• Perform other related duties as required.

Essential Functions

• Understand OLTL Medicaid Waivers and Act 150 program, CHC, regulations, policies, and procedures.
• Be knowledgeable of physical disabilities, associated limitations to Activities of Daily Living (ADLs), Instrumental ADLs, and relevant supports.
• Be technology-savvy and able to work remotely using videoconference and telephonic platforms. This position is part time telework.
• Ability to work independently, self-initiator.
• Organize and deliver presentations.
• Ability to prioritize tasks.
• Ability to explain programmatic requirements to participants, providers, and other stakeholders.
• Ability to effectively communicate both orally and in writing.
• Understand and interpret local, federal, and state laws as relevant.z
• Working knowledge of Microsoft Office, HCSIS, Docushare, Excel, Microsoft Teams, One Drive, PIA, ECIS, and Access and PROMISe.   
• Travel independently with overnight stays, without available public transportation.

Qualifications:

Bachelor of Social Work from an Accredited Social Work Program or equivalent education and experience.  Experience as a Service Coordinator desired working with OLTL programs or CHC is a plus.

Strong computer skills to include, but not limited to, Microsoft Office Products.

• Strong interpersonal skills for working with home and community service providers, people with disabilities and/or aged individuals.
• Demonstrated ability for written and oral communication.
• Strong organizational skills with attention to detail.
• Ability to work independently in telework status.

About Us:

TulaRay partners with clients to create staffing solutions that meet unique organizational needs. Our services are designed to reduce administrative burdens, protect your brand, and improve assignment time-to-fill. We believe that mutually successful client relationships are built on lasting quality and exceptional customer service. We pride ourselves on our uncompromising commitment to high-quality emergency management & healthcare personnel, while ensuring that our clients are taken care of with personalized attention. TulaRay manages total compliance and respectfully supports hundreds of professionals and patient-centered programs.

TulaRay is proud to be an affirmative action employer and is committed to providing equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. If you have a disability or special need that requires accommodation, please let us know by visiting our website at tularay.com