Job Title: WAIVER CLINICAL REVIEW COORDINATOR
Reports To: Waiver Program Supervisor
Scheduled Hours: Full-Time (37.5 hrs. per week)
FLSA Status Exempt
Purpose of Position:
The Waiver Clinical Review Coordinator will focus on documentation and process management of the MI Choice Waiver Supports Coordinators. This will ensure compliance with state and federal requirements, and that appropriate, patient-centered, quality care is being provided. Outside of these responsibilities, the Waiver Clinical Review Coordinator will fulfill their regular case manager duties with an adjusted case load.
Essential Functions:
- Policy Alignment
- Ensure that care coordination and all documentation including but not limited to person centered care plans, assessments, reports, etc. meet MDHHS standards.
- Confirm staff follow Milestone policies and processes for documentation.
- Assist leadership in interpreting and applying changes in Medicaid and MDHHS policies, MI Choice contracts, and accreditation requirements to real-world practice.
- Coordinates with Waiver Clinical Mentor to identify points for additional education for both the team and individuals.
- Bridges the gap between policy expectations and care delivery.
- Assist Waiver Leadership in developing policy and procedures.
- Continuous Improvement
- Bring forward identified trends in areas of both clinical concern and documentation to facilitate analysis and early intervention.
- Work with Waiver Leadership to review root causes and brainstorm possible solutions.
- Partner with Waiver Leadership and the Waiver Clinical Mentor to develop small quality improvement projects, tools, or workflows that help the team stay organized and consistent.
- Assist in identifying points for process improvement projects (Plan, Do, Check, Act - PDCA), developing and tracking the PDCA process.
- Identify staff who need additional support.
- Audits
- Work with Waiver Leadership to determine and implement appropriate actions to address issues identified in our audits, to strengthen our compliance with external auditors (CARF, CQAR, HCBS, Medicaid, etc.).
- Assist Waiver Leadership with preparation, and follow-up for external audits, including organizing clinical documentation and supporting work in areas of focus for process improvement activities.
- Performance Feedback and Evaluation:
- Provide feedback to the Waiver Supervisor about the progress of the clinical team, areas of strength, and areas needing improvement
- Collaborative Work with Supervisors:
- Work directly with the Waiver Supervisor and program manager to align training efforts, changes in processes and program goals.
- Ensure that the clinical team training aligns with the team's objectives, including case-load management, documentation quality, and customer service.
Education/Experience:
- A professional licensure (e.g., LLBSW, LBSW, LLMSW, LMSW, RN) is required.
- A minimum of two years of experience in a support’s coordination or case management role, such as in a managed care program or a similar role.
- Experience in supervision, mentorship, medical documentation, or providing training is highly desirable.
- Previous experience with compliance standards in managed care programs is required.
Competencies:
- Communication Skills: Strong verbal and written communication skills to deliver effective training and provide constructive feedback.
- Quality: Ability to understand and interpret state and federal regulations for long-term care and what they look like in clinical practice.
- Organizational Skills: Ability to manage all the regulations that need to be monitored, manage work schedule, and have clear information/data on trends.
- Adaptability: Ability to adjust changes in requirements, policies and processes.
- Problem-Solving: Ability to identify challenges staff are facing with regulations and requirements and develop strategies to address those with leadership.
Compensation & Benefits
- Benefits packages include:
- Medical, dental, vision
- 403b retirement plan with matching
- Short term disability
- Life insurance
- Employee assistance programs (EAP)
- Robust Paid Time Off (PTO) accrual
- Flexible scheduling to promote a great work/life balance
Who is Milestone Senior Services?
Our mission is to provide options that empower people to thrive in their community.
Core Values: Collaboration, Dedication, Resourcefulness, Inclusivity, and Integrity.
Milestone Senior Services (formerly Senior Services, Inc.) has been delivering to the Kalamazoo and surrounding communities for over 50 years. We encompass over 20 services that support the independence and well-being of older adults, adults with disabilities and caregivers throughout Southwest Michigan. We are dedicated to working in a collaborative manner with individuals in need, family members, and all others that support those we serve to live a healthy, meaningful, and productive life.
Why join Milestone Senior Services?
As a team member you will have the opportunity to work with mission driven co-workers within an environment that values their team members and creates great work/life balance. Milestone Senior Services embraces the belief that cultural, social, and all other differences should be respected and celebrated. Team members enjoy a well-rounded benefits package that includes 20 days of PTO in the first year of employment, 9 paid holidays + 1 floating holiday, 403b plan matching, and other employee-based assistance programs!
Additional Information
Milestone Senior Services is a drug-free, tobacco-free workplace and participates in E-Verify. All applicants will undergo a reference check, pre-employment drug testing, and a State of Michigan background check. Milestone Senior Services is an equal opportunity employer and welcomes a diverse field of qualified candidates.
Benefits:
- 403(b)
- 403(b) matching
- Dental insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Mileage reimbursement
- Paid time off
- Vision insurance
Application Question(s):
- Please provide your personal email for contact regarding this position.
License/Certification:
- Michigan RN or Social Work License (Preferred)
Work Location: Hybrid remote in Kalamazoo, MI 49001
