Level of Care Reviewer: OIDD-Central Office

Full Job Description

This position provides clinical review and determination of level of care and eligibility for individuals seeking services through OIDD programs, including HCBS waivers, ICF/IID admissions, TEFRA, and PASRR Level II processes:

Reviews submitted OIDD Home and Community-Based Services (HCBS) waiver documentation for initial and annual level of care determinations.

Applies sound clinical judgment to evaluate assessment results, reliability, and test validity; determines whether documentation supports established policy; collaborates with staff to obtain additional information when needed; and prepares clear, accurate, and concise clinical summaries to support diagnoses, supervision needs, and level of care determinations.

Reviews submitted documentation for initial Intermediate Care Facility for Individuals with Intellectual Disabilities admission level of care determinations.

Uses clinical expertise to evaluate assessment results and test validity; ensures compliance with established policy; communicates with division staff and providers regarding documentation needs; and prepares concise clinical documentation supporting applicable diagnoses, supervision needs, and level of care determinations.

Reviews submitted documentation for TEFRA initial level of care determinations to assess compliance with OIDD eligibility policy.

Applies clinical judgment to evaluate assessment results and test validity; determines whether additional testing is warranted; collaborates with staff to obtain supplemental documentation as needed; and prepares clear, accurate clinical summaries supporting diagnoses, supervision needs, and level of care determinations.

Reviews submitted Preadmission Screening and Resident Review (PASRR) documentation to determine compliance with OIDD policy under intellectual disability or related condition criteria.

Evaluates the need for active treatment versus services of lesser intensity; applies clinical judgment to available assessments; and prepares clear, concise clinical summaries supporting Level II determinations and formal level of care decisions.

Supports and defends select Initial LOC outcomes to South Carolina's Department of Health and Human Services Quality Improvement Organization (QIO).

Engages in collaboration through monthly and quarterly required meeting attendance and consistent communication with OIDD leadership and peers. Participates in professional development courses as required.

Performs other related duties as assigned to support departmental or Agency goals.

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 license to practice Psychology in the state of South Carolina or a master's degree in Applied Psychology and 4 years clinical experience subsequent to master's degree.

Qualifications

Understanding of OIDD eligibility criteria for Intellectual Disability (ID); Related Disability (RD); Autism Spectrum Disorder (ASD); Traumatic Brain Injury (TBI) and Spinal Cord Injury (SCI), as well as other OIDD categories. Knowledge of medical conditions and genetic disorders that have a high correlation to ID. Familiarity with South Carolina's Medicaid process for Level of Care determinations ranging from Home and Community Based waiver enrollment; TEFRA Medicaid determination; PASRR determination and Facility Admission. Knowledge of DSM-5 diagnostic criteria, commonly used psychological assessment tools as well as the ability to asses and interpret psychological test results/validity of testing. Ability to prepare clear, accurate and concise summarizations of available clinical documentation that support OIDD diagnoses and current supervision needs as defined by policy.

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)