Level of Care Reviewer: OIDD - Central Office

Full Job Description

This position provides level of care assessment during the Home and Community Based Level of Care (LOC) review and approval process as well as the Head and Spinal Cord Injury (HASCI) Nursing Facility Annual LOC review and approval process; making the final determination as to whether each applicant meets/continues to meet (ICF-IID) LOC requirements as outlined in OIDD and Medicaid policy. Provides assessment for other SC Medicaid funded programs that also require an ICF-IID LOC determination. Provides as-needed training and support to provider staff based on departmental analysis of data trends and outcomes. Supports team goals and participate in cross-functional training projects to help drive specific data results.

Accurately reviews Initial Level of Care (LOC) submissions for individuals pending enrollment in two OIDD operated Home and Community Based Waiver programs.

Ensures the applicant has a documented intellectual or related disability as well as has identified areas of supervision and skills training needs per policy and state code.

Works in tandem with clinical/file review staff to determine appropriate LOC outcome.

Responsible for notifying customers of the OIDD Reconsideration process for (ID-RD) and (CS) LOC outcome, when required.

Works directly with Division and Provider staff when documentation limitations/accessibility issues are identified and maintains contact until all compliance issues are resolved.

Demonstrates a high level of detail and accuracy.

Accurately reviews Annual Level of Care (LOC) submissions for individuals who are seeking continued enrollment in the OIDD operated Home and Community Based HASCI Waiver program.

This review process ensures the applicant continues to meet SC Medicaid established guidelines for either intermediate or skilled LOC determination.

Responsible for notifying customers of the OIDD Reconsideration process when required.

Works directly with Division and Provider staff when documentation limitations/accessibility issues are identified and maintains contact until all compliance issues are resolved.

Demonstrates a high level of detail and accuracy.

Requires proficiency in data analysis and PowerPoint presentation functionality. Must have the ability to present complex information in a comfortable and non-technical manner.

Responsible for creation of quarterly or as needed virtual trainings that address key areas of need with helpful, concise content, high-quality visuals and confident delivery.

Participates in the PASRR Level II evaluation process to determine if admission to a SC Medicaid certified nursing facility is appropriate for an individual with an intellectual disability or a related condition; and to determine if specialized rehabilitative services are needed from the facility or if specialized services are needed beyond standard nursing facility care.

Participates in professional development.

Completes other duties as assigned.

BHDD-OIDD is a part of the state's behavioral health and developmental disabilities agency, providing services for individuals with intellectual and developmental disabilities, mental health conditions and substance use disorders through a wholistic, streamlined and coordinated approach. OIDD assists in the planning, developing, coordinating, and funding services for South Carolinians with the severe, lifelong disabilities of intellectual disability and related disabilities, autism spectrum disorder, traumatic brain injury, and spinal cord injury and similar disability.

Requirements

A bachelor's degree from an accredited college or university in Health and Human Services or a related field, and at least (1) year of relevant program or case management experience working with individuals who have been diagnosed with intellectual developmental disorder (intellectual disability), conditions related to intellectual disability (related disability), autism spectrum disorder, traumatic brain injury, similar disability and/or spinal cord injury.

Qualifications

Home and Community Based Waiver case management experience highly preferred. General proficiency in data analysis and critical thinking preferred. Knowledge of South Carolina (SC) OIDD eligibility diagnostic criteria as well as knowledge of policy/procedure relative to the SC Medicaid Level of Care (LOC) review and approval process for any/all of the following: Home and Community Based Waiver enrollment, Intermediate Care Facility admission, Preadmission Screening and Annual Resident Review Assessment (PASRR), Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA).

Must demonstrate a high level of detail and accuracy; must communicate well and maintain productive working relationships as part of a highly communicative team.

Additional Information

Employment Contingency: Employment is contingent upon our receipt of the following required pre-employment screenings: medical screening – to include a drug screening; background record checks (to include fingerprinting), South Carolina Department of Social Services’ Child Abuse and Neglect Central Registry screening, U.S.

Department of Health and Human Services Office of Inspector General “List of Excluded Individuals/Entities” screening; South Carolina Department of Motor Vehicles Driving Record check; and a review of transcripts verifying educational credentials.

We reserve the right to rescind an offer of employment in the event minimum requirements are not met to include positions that require certifications and/or licensure, your application is incomplete or inaccurate, or our review of your background uncovers information, including opinions of previous employers and references, which cause us to conclude, at our sole discretion, that you are not suited for the position.

Immunization: If this position requires the applicant to work directly with consumers of The South Carolina Department of Behavioral Health and Developmental Disabilities, Office of Intellectual and Developmental Disabilities, tuberculosis (TB) skin or blood testing must be completed prior to beginning employment.

All new employees who are healthcare providers are required to provide documentation of immunity or be immunized against measles, mumps, rubella, pertussis, Varicella and Hepatitis B prior to beginning employment.

State Disaster Plan: In accordance with the State's Disaster Plan, which includes hazardous weather, employees of The South Carolina Department of Behavioral Health and Developmental Disabilities, Office of Intellectual and Developmental Disabilities may be required to work in times of an emergency or disaster.

Employee Referral: The South Carolina Department of Behavioral Health and Developmental Disabilities, Office of Intellectual and Developmental Disabilities supports a Referral Incentive Reward and a Retention Bonus program.

You may contact Human Resources for further information. Supplemental Questions: Supplemental questions are considered part of your official application.

Any misrepresentation will result in your disqualification from employment. Please complete the State application to include all current and previous work history and education.

A resume will not be accepted nor reviewed to determine if an applicant has met the qualifications for the position.

The South Carolina Department of Behavioral Health and Developmental Disabilities is committed to providing equal employment opportunities to all applicants and does not discriminate on the basis of race, color, religion, sex (including pregnancy, childbirth, or related medical conditions including, but not limited, to lactation), national origin, age (40 or older), disability or genetic information.

The South Carolina Department of Behavioral Health and Developmental Disabilities, Office of Intellectual and Developmental Disabilities offers an exceptional benefits package for FTE positions that includes:

• Health, dental, vision, long-term disability, and life insurance for employees, spouse, and children. Click here for additional information.
• 15 days annual (vacation) leave per year
• 15 days sick leave per year
• 13 paid holidays
• Paid Parental Leave
• S.C. Deferred Compensation Program available (S.C. Deferred Compensation)
• Retirement benefit choices*
  • State Retirement Plan (SCRS)
  • State Optional Retirement Program (State ORP)