FCMA Lead Worker

Family & Children's Medicaid Recertification Team Lead Worker. FCMA and NC Fast experience required. Training, and Second Party Reviews experience preferred.

Primary Purpose - The Income Maintenance Caseworker III (Lead Worker) position is responsible for  conducting 2nd party reviews in the Family & Children's Medicaid program for the purpose of (Resource Management) in all program areas. The worker will assist the Family & Children's Medicaid Supervisors and Staff Development in training and administration of the Medicaid programs for all areas. This worker will assist with the intake and recertification process when needed, including determination of eligibility for all program areas.

This worker is responsible for determining and managing Foster Care and Adoption Medicaid, Breast and Cervical Cancer Medicaid and a specialized caseload. Flexibility and adaptability are critical as this position serves as a "fill-in" at times when workers are out for an extended period or there is a vacancy. The worker is responsible for keying and processing all cases, recertifications and all other information within NC Fast.

This worker is required to read and interpret Medicaid policy for all program areas, along with Dear County Director Letters, Change Notices, and Job Aids as issued by the State/NCFAST. This caseworker must interact and communicate exceptionally well with supervisors, co-workers, attorney's and the public. This person must be able to tolerate workers with different personalities, as well as those who work differently and at a different pace than others.

This position is from 8:00 am until 5:00 pm., Monday through Friday with one hour for lunch. Overtime is required as needed and will include overtime during the week and/or on weekends, on occasion.

II. Duties and Responsibilities

* This worker is responsible for reporting directly to the Family & Children's Medicaid Supervisors. This worker will work with Caseworkers in all areas of Family & Children's Medicaid.

* Worker will be responsible for assisting the Family & Children's Medicaid Supervisors in the administration of the Family & Children's Medicaid Programs. Duties will include planning, outreach, and training of new and seasoned staff. Worker will be involved in the actual daily functions in all program areas that could involve taking and processing of applications and recertifications as needed. Worker will assist Supervisor with the completion of second party reviews monthly for the Single CAP Audit report and as audits occur.

Worker will assist Supervisor with the implementation of Corrective Action plans for staff when needed and monitoring of performance.

* Worker in this position functions as a trainer, helper, reviewer, and caseworker as needed. This worker must be very knowledgeable with the various programs in Income Maintenance, such as Family & Children's Medicaid, Adult Medicaid, Special Assistance & Food & Nutrition Services.

* Worker must have considerable knowledge of all agency and community programs and services which could affect the client/applicant.  This worker must have the ability to analyze, interpret rules and regulations for various programs.  Worker must have the ability to train employees in new and existing rules, regulations, policies, and procedures. Worker must have the ability to understand the needs and problems of the clients/applicants and assist with irate clients when needed.

This worker must be able to function within structured time frames.  In addition to explaining various program guidelines, the worker must also explain the rights and responsibilities of the client/representative and the appeal rights.

* All applications taken by the worker in this position must be processed timely according to the timely State standards. Workers must verify all electronic verifications such as OVS, and Work Number verifications within NCFAST. Applications are 45 days however, there are circumstances when the case may pend for up to six months.

* Employee will be expected to work in emergency shelters and/or perform related disaster tasks and perform other reasonable tasks requested by the Deputy Director or Director.  

III. Other Position Characteristics

* Accuracy Required in Work:  Accuracy is of the utmost importance.  This position requires mental concentration at all times because it is necessary that work be done as mandated by guidelines in all Adult Medicaid & Special Assistance programs.

* Consequence of Error:
Perfection is demanded in this position.  The results of an error in determining eligibility could mean county charge backs and the authorization of benefits in error. The workers decisions can be critical to continued assistance to clients and the appropriate reimbursement to medical institutions for services rendered.  

* Instructions Provided to Employee:  Instructions may be written and/or verbal.

* Guidelines, Regulations, Policies and References Used by Employee:
The type of guidelines and reference…