Medical​/Social Services Consultant II

Introduction

Make a Difference with DHSS. Our mission at the Department of Health and Social Services (DHSS) is to improve the quality of life of Delaware citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations. We prioritize personal and family independence by assisting individuals and families in a variety of life areas. We offer numerous career opportunities and are dedicated to attracting and retaining highly talented individuals who are ready to make a difference in their community today.

DHSS is a great place to kick-start your profession. For more information, please visit (Use the "Apply for this Job" box below). today!

This advanced-level role in the Division of Medicaid and Medical Assistance (DMMA) Quality Team oversees Managed Care Organization (MCO) performance by auditing waiver programs, reviewing critical incidents, tracking data, and supporting quality improvement. The position consults on complex case management, identifies service trends, and contributes to policy and program improvements. The position collaborates with providers, agencies, and community partners to promote compliance, health equity, and outreach related to Social Determinants of Health (SDOH).

• Manages cases over the continuum of a healthcare delivery system for clients with complex, chronic, and specialized physiological medical conditions. Facilitates access to medical and social service resources across public, private, and community sectors.
• Collaborates with health care providers, services, programs, and insurance entities to develop tailored service plans and interventions. Integrates care and communication between stakeholders to ensure optimal health and social outcomes.
• Navigates and consults on the intersection of services, authorizations, and payments between the clients, providers, insurance programs and/or Managed Care Organizations. Works with providers and insurance entities to obtain pre-authorizations and referrals.
• Schedules and attends multidisciplinary evaluations and assessments. Facilitates and participates in discharge and transition planning.
• Formally responds to casework inquiries and investigates complaints, assessing services or eligibility against legal entitlements or contracts.
• Provides subject matter expertise through outreach and education to program staff, community members, providers, and other stakeholders through special community events or health education and preventative services. Advocates for community health and wellness.
• Maintains and tracks service, eligibility, and referral data sets, manages data for reporting and program planning. Coordinates and allocates funding sources for special program eligibility.
• May support emergency preparedness and response efforts during pandemics or natural disasters, and/or intervene in facilitating care for clients in health crisis. May provide home visits, and/or virtual appointments.
• Performs other related duties as required.

• Possession of a Bachelors degree or higher in Health, Behavioral or Social Science or related field.
• Two years' experience in case management such as assessing, planning, developing, implementing, monitoring, and evaluating options and services to meet an individual's human service needs.
• Two years' experience in making recommendations as part of a client's service plan such as clinical treatment, counseling, or determining eligibility for health or human services/benefits.
• Two years' experience in client healthcare resource coordination and support.
• Six months experience in interpreting laws, rules, regulations, standards, policies, and procedures.
• Six months experience in narrative report writing.

All new hires are required to report to the Statewide New Employee Orientation (SNEO) on their first day of employment. Sessions are held at designated locations in Kent or New Castle County. Applicants must be legally authorized to work in the United States. The State of Delaware participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. For more information refer to our Job Seeker Resources.

DHSS does not provide employment-based sponsorship.

To learn more about the comprehensive benefit package please visit our website at /

The application and supplemental questionnaire are evaluated based upon a rating of your education, training and experience as they relate to the job requirements of the position. It is essential that you provide complete and accurate information on your application and the supplemental questionnaire to include dates of employment, job title and job duties. For education and training, list name of educational provider, training course titles and summary of course content.

Narrative information supplied in response to the…