Imc Ii-Adult Medicaid

Income Maintenance Caseworker II – Long Term Care Adult Medicaid

Department:
Social Services

Non-Exempt

The Income Maintenance Caseworker II is responsible for determining eligibility and managing ongoing cases for economic services programs, specifically Adult Medicaid, Long Term Care, and Special Assistance in accordance with federal, state, and county policies. Work is performed using the NC FAST (North Carolina Families Accessing Services through Technology) system related to the enrollment and eligibility for the departments’ economic services programs.

This position requires a high level of independence, detailed case management, and frequent communication with clients, long-term care facilities, legal representatives, and other community partners. The role also demands a strong understanding of complex policy and procedures as well as attention to legal and financial factors that impact eligibility.

• Conducts interviews with applicants and recipients, either in person or by phone, to gather necessary information for eligibility determination.
• Input client information; research and verify client information as needed.
• Reviews and processes applications for Long-Term Care, CAP (Community Alternatives Program), PACE, Special Assistance, Special Assistance In-Home, Adult Medicaid, and Medicare Qualified Beneficiary (MQB) programs.
• Makes determinations regarding client eligibility for program services; ensures determinations are in compliance with program and agencies policies and guidelines.
• Complete estate recovery documents; addresses insurance changes, liability payment changes, monthly payment changes, working program changes, recovery of over payments, and underpayment issues.
• Make eligibility determinations and redeterminations in compliance with Medicaid program rules and county procedures.
• Maintain accurate and up-to-date electronic and paper case records with required documentation.
• Troubleshoots and resolves issues within client cases, collaborating with supervisors and lead staff as needed.
• Interprets and applies program policy, ensuring clients receive accurate and timely service.
• Completes program-specific training on policy principles and updates.
• Prepare and send required notices of eligibility, ineligibility, or additional information requests.
• Refer suspected fraudulent activity to the appropriate investigative personnel.
• Completes state-mandated reports accurately and within required deadlines.
• Assist clients with Disability Determination Services decisions as needed.
• Provides support and case management to clients in hospital settings and conducts Special Assistance facility visits as assigned.
• Perform other related duties as assigned.

• Working knowledge of federal, state, and local policies governing Medicaid eligibility.
• Knowledge of client services principles and practices.
• Problem-solving skills and the ability to adapt to policy or procedural changes.
• Ability to prioritize tasks, manage time effectively, and work independently.
• Skill in interpersonal relations.
• Skill in operating computers and job-related software programs.
• Strong communication skills—both oral and written—with the ability to explain complex eligibility information clearly to clients.
• Good mathematical reasoning and computational skills, with the ability to perform calculations related to income, budgets, and eligibility determinations.

• Work is primarily performed in an office environment with standard hours.
• Occasional walking, standing, or stooping may be required.
• Must be able to lift and move office supplies up to 25 pounds.
• Local travel may be required to attend training sessions, perform fieldwork, or visit clients and facilities.

• Thorough knowledge of income maintenance program assigned. Considerable knowledge of all agency and community programs and services which could affect the client/applicant. General knowledge of all Adult Income Maintenance programs.
• Good mathematical reasoning and computational skills. Ability to read, analyze, and interpret a variety of regulations, policies and procedures of varying complexity.
• Ability to work independently and prioritize work.
• One year of experience as an Income Maintenance Caseworker; or an equivalent combination of training and experience.
• 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.