Sr Income Maintenance Caseworker Qc Family Medicaid

SR INCOME MAINTENANCE CASEWORKER QC FAMILY MEDICAID

Job Description

Senior Income Maintenance Caseworker

DEPARTMENT:
Social Services, Lincoln County 7682

JOB SUMMARY:

This position is responsible for various quality control activities to help ensure agency compliance with State and Federal policy, rules, and statutes.

This position reviews and analyzes recipient records to ensure appropriate determinations of eligibility and to support continuous quality improvement in the management of income management cases. In this role staff must be knowledgeable of policies and procedures in economic services programs, including but not limited to Food & Nutrition Services and Work First Family Assistance, as well as other programs as directed by the CQI Social Worker Supervisor and agency Director.

MAJOR DUTIES:

• Reviews Income Maintenance Caseworker records to ensure accuracy and timeliness; analyzes case records and determinations; verifies computations; randomly selects cases for audit.
• Creates monthly audit reports, including reports for submission to the state.
• Reads, analyzes, and interprets regulations, policies and procedures.
• Analyzes case records and determinations periodically as required for state auditing requirements.
• Performs eligibility determination functions and maintains caseload as needed.
• Attends workshops and training sessions.
• Communicates with supervisor regarding rebuttals of finding submitted and to resolve errors.
• Provides training for less-experienced personnel as needed.
• Collaborate with Program Integrity Investigator as needed to assist with interviews and case investigations. Also, to report cases of over issuances as identified.
• Performs related duties as assigned.
• Collaborate with various stakeholders, including state agencies, program managers, supervisors and other Food and Nutrition staff.

KNOWLEDGE REQUIRED BY THE POSITION:

• Knowledge of agency and program policies and procedures.
• Knowledge of record review and auditing principles.
• Knowledge of state and federal guidelines and regulations.
• Knowledge of computers and job-related software programs.
• Knowledge of customer service principles.
• Skill in conducting eligibility determination analysis.
• Skill in analyzing data and preparing reports.
• Skill in problem solving.
• Skill in prioritizing and planning.
• Skill in interpersonal relations.
• Skill in oral and written communication.

SUPERVISORY CONTROLS:

The CQI Social Work Supervisor assigns work in terms of general instructions. The supervisor spot-checks completed work for compliance with procedures, accuracy, and the nature and propriety of the final results.

GUIDELINES:
Program policy manuals, state policies, agency policies, and county policies and procedures. These guidelines require judgment, selection, and interpretation in application.

COMPLEXITY:
The work consists of varied record review, auditing, and eligibility determination duties. Strict regulations and the unique nature of each case contributes to the complexity of the position.

SCOPE AND EFFECT:
The purpose of this position is to review and audit the eligibility determination process. Successful performance contributes to the successful delivery of programs and services to eligible clients in compliance with program policies and procedures.

PERSONAL CONTACTS:
Contacts are typically with agency and county staff, and state program, quality control, and monitoring staff, along with any other individual/entity auditing/reviewing agency programs/services.

PURPOSE OF CONTACTS:
Contacts are typically to give or exchange information, provide services, motivate personnel, resolve problems and provide training.

PHYSICAL DEMANDS:
The work is typically performed while sitting at a desk or table or while intermittently sitting, standing, stooping, bending, crouching, or walking. The employee occasionally lifts light objects.

WORK ENVIRONMENT:
The work is typically performed in an office.

SUPERVISORY AND MANAGEMENT RESPONSIBILITY:
None.

MINIMUM QUALIFICATIONS:

• Knowledge and level of competency commonly associated with completion of specialized training in the field of work, in addition to basic skills typically associated with a high school education. Associate degree preferred.
• Sufficient experience to understand the basic principles relevant to the major duties of the position, usually associated with the completion of an apprenticeship/internship or having had a similar position for one to two years.
• Possession of or ability to readily obtain a valid driver’s license issued by the State of North Carolina for the type of vehicle or equipment operated.
• Strong analytical and problem-solving skills; data analysis skills; communication and interpersonal skills.
• Knowledge of Food & Nutrition Services programs and Work First Family Assistance.
• Familiarity with compliance monitoring and federal regulations.
• The ability to provide technical assistance to develop and deliver training materials.
• Strong skills in conflict resolution, collaboration and coaching.