IL PASRR Project Support Specialist Part Time

4 weeks ago

Reston, Virginia, United States Demo - Maximus Full time

Job Summary:

This part-time position involves performing document-based and telephonic utilization review for contracted services. The successful candidate will screen for diagnosis or suspicion of serious mental illness and/or intellectual disability, and medical necessity for short or long-term nursing facility placement.

Key Responsibilities:

  • Make outbound phone calls to nursing facilities to determine eligibility for preadmission, concurrent reviews for admissions, continued placement in Medicaid certified nursing facilities, utilizing federal and State's criteria.
  • Schedule document-based quality reviews that adhere to statedirected clinical criteria for determining medical need.
  • Reviews and communicates all information with providers, utilizing computer database system for determining nursing facility placement appropriateness.

Additional Responsibilities:

  • Utilizes both referral screens and medical records review to make determinations.
  • Responsible for pulling data from multiple systems, performing data analysis, and then initiating robotic process automation jobs to move data between systems.
  • Review rejected data and troubleshoot the cause, and correct any source files to prevent future occurrences of rejects.
  • Perform data analysis functions to ensure integrity of data in systems used by the program. Some intermediate to advanced Excel skills are necessary to reconcile data between systems.
  • Monitor multiple work queues daily to ensure cases move quickly through each process stage. If data errors or human errors are preventing the case from moving forward, determine and resolve the problem.
  • Assist with monthly billing and quarterly reporting processes which includes extracting data from two systems, performing analysis to consolidate data found in both systems, and perform manual research when data has not been properly entered.
  • Provide feedback to Program Manager of the types of errors and root causes.
  • Review submitted evaluations for potential duplicates. Make outbound calls to facilities to determine cause.
  • Track high volume and/or difficult to reach facilities. Pull queries to identify which facilities have caused the turnaround time contractual standard to be missed, so data can be reported to the State.
  • Complete other job duties as assigned or necessary.

Requirements:

  • High School diploma or equivalent with 4+ years of professional experience working with persons with serious mental illness and/or intellectual disability, or AA degree with 2+ years of professional experience working with persons with serious mental illness and/or intellectual disability.
  • Bachelor's degree in human services related field preferred.
  • Perform all job duties in compliance with Person First standards, HIPAA guidelines, and company confidentiality policies and procedures.
  • Excellent knowledge of diverse cultures and issues, with the ability to incorporate special needs into utilization review decisions.
  • Working knowledge and understanding of behavioral health diagnoses, psychotropic medications, medical diagnoses, and prescribed medications.
  • Excellent ability to multitask while effectively performing job duties, which include prioritizing tasks; ensure all voice mail and email messages are monitored and responded to within 2 hours of receipt.

Preferred Qualifications:

  • Ability to work independently, as well as within a team while exhibiting excellent interpersonal skills.
  • Excellent written and verbal communication skills.
  • Ability to interact professionally with providers (hospital & nursing home staff, physicians, community service workers, etc.), state contract officers, and coworkers while seeking or providing information.
  • Ability to collect data, define problems, establish facts, and draw valid conclusions for supporting a superior written rationale for review determination.
  • Excellent computer skills with experience in word processing, email, and spreadsheets (Microsoft Word, Outlook preferred and intermediate (to advanced) Excel skills).

About Maximus:

Maximus is a leading provider of government services, helping citizens around the globe to successfully engage with their governments at all levels and across a variety of health and human services programs.

We deliver innovative business process management and technology solutions that contribute to improved outcomes for citizens and higher levels of productivity, accuracy, accountability, and efficiency of government-sponsored programs.

With more than 30,000 employees worldwide, Maximus is a proud partner to government agencies in the United States, Australia, Canada, Saudi Arabia, Singapore, and the United Kingdom.

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