Michigan Public Health Institute s2

To Be Completed By Human Resources Classification ______Salary Grade ______

Michigan Public Health Institute Position Description

Title: MI Health Link Nurse Case Reviewer

Employee Name: TBD

Supervisor: Roxanne Perry

Purpose: Assist with the review of C-waiver applications to determine if they meet all of the criteria to be approved. Also assist in the Integrated Care Organization’s C-waiver audits which includes off-site and on-site reviews. Assist in the clinical reviews of Nursing Facility Level of Care Determinations (LOCDs) to determine if they meet the criteria for approval.

Duties and Responsibilities:  Assisting with the review of C-waiver applications in the WSA data base. This includes but not limited to: 1) Reviewing C-waiver application for completeness including requirements in the 3-way contract and HCBS Final Rule 2) Reviewing the LOCD 3) Reviewing the care plan for c-waiver services and necessary information 4) Complete approval or denial letter

 Assisting with C-waiver audits. This includes but not limited to: 1) Reviewing ICO policies and procedures “off-site” 2) Reviewing member’s needs for waiver services “off-site” 3) Backup for C-waiver audits “on-site”

 Assisting with the review of Nursing Facility Level of Care Determinations (LOCDs). This includes: 1) Reviewing the LOCDs via the enrollment mailbox or paper copies 2) Requesting additional documentation from Integrated Care Organizations (ICO) as necessary 3) Complete approval or denial letter and send to ICO via secured e-mail 4) Complete tracking worksheet

Qualifications/Requirements:

Education: Holds current Michigan license as a Registered Nurse (RN) or Licensed Practical Nurse (LPN).

MPHI is an Affirmative Action/Equal Opportunity Employer

of 2 Experience: A minimum of one year of experience with the elderly, home care and/or regulatory experience preferred. Important Skills and Characteristics: Up-to-date clinical skills. Experience with the elderly population or adults with disabilities. Competence in using Word and Excel. Experience with state data systems (CHAMPS, LOCD) is preferred.

Work Environment and Physical Requirements: Job may require moderate physical effort including lifting materials and equipment of <50# and involves viewing a CRT or VDT screen 25% to 75% of the time. Standard office environment. Occasional ICO/home visits throughout the state of Michigan. .

RESPONSIBILITY FOR THE WORK OF OTHERS: No assigned responsibilities for others.

IMPACT ON PROJECTS, SERVICES AND OPERATIONS MI Health Link is a demonstration program in the Integrated Care Division. C-waiver services are services that are not included in the Medicaid State Plan Benefit package. The Integrated Care Organization must submit an application for approval before the C-waiver services are approved by the State. MI Health Link has 5,000 waiver slots available. Each application must be reviewed for the appropriate need and documentation. These services allow enrollees who meet nursing facility level of care to live independently in the community.

Nursing Facility Level of Care Determinations are necessary as a beneficiary must meet the nursing facility level of care criteria in order to be admitted to a long term care nursing facility or receive C-waiver services. The Integrated Care Division must approve the LOCDs that are conducted by the ICO in order to fulfill the mandate of a conflict free LOCD process.

REQUIRED COMMUNICATION

Contact Person/Group Frequency Purpose 1. Roxanne Perry Daily Supervision 2. MPHI manager As needed Oversight

For purposes of employment standards, this classification is “Exempt” from the overtime provisions of the Fair Labor Standards Act.

Signature______Date______Employee Signature

Signature______Date______Supervisor or Program Director

MPHI is an Affirmative Action/Equal Opportunity Employer

of 2 MPHI is an Affirmative Action/Equal Opportunity Employer