Medicaid Presumptive Eligibility Specialist

2 weeks ago

Bloomfield, NJ, United States Partnership for Children of Cumberland County Full time

Partnership for Children of Essex (PCE) is a private non-profit care management organization (CMO) dedicated to assisting youth with complex needs that include: emotional/behavioral, intellectual/developmental and substance use. PCE is a part of New Jersey's Children's System of Care. PCE utilizes a Wraparound model of care while working in partnership with youth and families to design and implement a plan of care that is specific to the youth's individual strengths and needs. PCE is committed to keeping youth safe in their home, school, and community.

Partnership for Children of Essex (PCE) is currently seeking aMedicaid Presumptive Eligibility (PE) Specialist.

Qualified Candidates will be able to do the following:

  • Assist with reviewing eligibility documents and calculate household income to determine initial and continuing eligibility for Medicaid coverage in accordance with federal, state, and agency regulations.
  • Record and track Medicaid eligibility upon admission and ongoing basis.
  • Assist Care Managers and management in gathering additional information as it relates to Presumptive Eligibility/Medicaid enrollment.
  • Track various systems to conduct searches for initial applications, redetermination, and pending applications.
  • Effective communication with families and Medicaid by phone and written correspondence.
  • Ability to explain program requirements and procedures to Caregivers.
  • Ability to enter data via internal and external databases with high regard to accuracy.
  • Counseling families regarding program eligibility requirements and their rights and responsibilities.
  • Participate in staff meetings and training workshops.
  • Provide quality customer service to families.
  • Coordinate, prepare, and distribute appropriate communications to Caregivers.
  • Maintain, secure, and safeguard confidential information.
  • Gather and analyze documents received for authenticity, validity, and accuracy.
  • Provide support in other areas as requested, assigned, or directed to meet the needs of the Department.
Knowledge and Skills:
  • Strong verbal and written communication skills.
  • Ability to communicate effectively with diverse populations.
  • Strong critical thinking, analytical, and problem-solving skills.
  • Strong attention to detail.
  • Strong organizational skills.
  • Ability to multi-task in a fast-paced environment.
  • Ability to perform intermediate-level math.
  • Ability to enter data with a high degree of speed and accuracy.
  • Ability to meet productivity standards within established timelines.
  • Knowledge of Medicaid eligibility.
  • Knowledge of Microsoft Office.
Education and Experience:
  • High school diploma required; associate degree preferred
  • Experience in human services preferred
  • Bilingual in Spanish, Portuguese, or Creole a plus.


The Partnership for Children of Essex (PCE) is a non-profit organization dedicated to creating a pathway for hope and improving the quality of life for youth and their families.

Excellent benefits including medical, dental & vision, 403(b), generous PTO, life insurance, flexible schedule.

PCE is An Equal Opportunity Employer- M/F/D/V

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