Location: Fully Remote (Candidates can reside anywhere in the USA, but must have knowledge of Ohio's MyCare Waiver WITH a OH LICENSE)
SHIFT: Training - Mon-Fri 8am-5pm EST - about 4 weeks to complete all training - 1on1 and classroom - NO TIME OFF DURING TRAINING
Work schedule after training: Mon-Fri 8am-5pm EST - No OT unless needed - No weekends / holidays
Duration: 6 months, possible temp to perm
Description: This role will be responsible for the development, implementation, resolution and oversight of waiver incident reporting at member level and organizational level. The primary functions will include waiver incident reporting education, incident reporting, incident investigation, incident processing and closure. This position ensures compliance with client's Three-Way and Provider Contract along with the Ohio Administrative Code and CMS regulations delegated to client through the MyCare Ohio Waiver administered through the MMP in Ohio and other required Incident Reporting in Medical Management as outlined our MCO/MCOP Provider Agreements. The MyCare Ohio Waiver is a 1915 c waiver approved by CMS for Ohio.
Job Purpose: The purpose of the team is to identify critical incidents for client's Health Plan's Medicaid and MyCare members and ensure timely submission into the Ohio Department of Medicaid Incident Management System (IMS)
). This team reviews the incidents and works with the care coordination teams to create person-centered prevention plans to help ensure the health, safety and welfare of all our members
Typical Day in the Role - The incident investigator is responsible for timely submission of critical incidents into the IMS system. The investigator reviews claims data, clinical data, case management notes and assessments.
- The investigator is responsible for ensuring the incident submitted is a critical incident and review of the case is completed within 45 days.
- The investigator will review all available data, collaborate with CC staff, CMEs, and law enforcement staff to either substantiate or unsubstantiate the case..
- Staff performance is evaluated through incident submission timeline, case closure time and insertion of appropriate prevention plan into IMS within 7 business days
This process is unique to Ohio
Applications - Trucare, OH incident management system, impact pro,
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Candidate Requirements Education/Certification Required: degree required in a field of Nursing, Social Work and/or Counseling. Preferred:
Licensure Required: RN, LSW, LISW, LPC or LPCC Preferred: Years of experience required: must have 5 years clinical experience within the candidate's licensure; must have knowledge of Ohio's MyCare plan and, or Ohio's Incident Submission Process; must have RN, LSW, LPC, LISW, LPCC
Disqualifiers:
Additional qualities to look for: Learns quickly, accountable for own actions, team player, but able to thrive independently. (managed care is a plus).
