Adult Case Manager/Medicaid Specialist

Brain Injury Services (BIS) helps children and adults with a brain injury build the skills and confidence they need to lead a fulfilling and productive life.

BIS is currently searching for a full-time Brain Injury Case Manager to serve our clients. We are looking for case managers with a strong case management background with a minimum of 2 years of experience. Preferences will go for candidates who have experience navigating Medicaid referrals, submitting service authorization, monitoring billing, and collaborating with Managed Care Organizations (MCO) in the Targeted Case Management (TCM) services for BIS clients. 

Position Service area: 

Prince William County and other areas as assigned by the department manager

Definition: 

Under the supervision of the Department Manager, Adult Case Management Services, the Case Manager is responsible for providing community-based case management to adults with acquired brain injury and their families in the Northern Virginia region. The adult brain injury program includes the provision of long-term case management services and public awareness. These services are provided using a model of community-based case management.

Distinguishing Characteristics: 

This position requires a professional level of intervention with complex cases. The Adult Case Manager position assumes the ability to work independently and exercise autonomy. The Department Manager may designate other duties. This position is guided by the mission of this organization to support individuals with brain injuries and their families in reaching their maximal level of functioning within their communities using a person-centered approach.

Essential Job Functions and Responsibilities:

• Serve and protect the agency by adhering to professional standards, federal, and local requirements; and MCO’s regulations.
• Obtain information and make referrals for appropriate services including TCM-related referrals, in addition to general referrals to community services. 
• Do a comprehensive intake evaluation including the completion of all documentation as designated in the Policy and Procedure Manual and obtain all necessary records from outside sources to assure a thorough evaluation and ensure service eligibility. 
• Complete all required paperwork related to Medicaid TCM services including service authorizations, assessments, evaluation, review, billing, and reporting.
• Complete a thorough client assessment, which includes the client’s strengths and weaknesses, family      and community support systems, a Needs assessment that covers all areas described in the Adult Brain Injury Case Management Policy and Procedure Manual, and the assessment of existing resources presently utilized by the client and gaps in service’s requiring intervention within 45 days of opening a case.
• Obtains appropriate releases understands the laws regarding confidentiality and upholds these laws.
• Completes all paperwork as described in the Policy and Procedure Manual and always maintains charts in an orderly fashion.
• Establish a solid therapeutic relationship with clients, their families, and their community providers. 
• Supports clients in developing their own goals and plans based on the needs assessment and utilizing various planning tools. Completes an Individualized Service Plan and provides a written copy to the client.
• Review the ISP every 90 and adhere to the MCO’s rules and regulations about service review. Clients’ signatures are required to ensure the client’s consent and participation in services. 
• Identify, coordinate, and monitor goal-directed community services to meet the client’s needs and desired activities as outlined in their plans.
• Maintain in-person and/or virtual contact with active clients and/or families at least monthly and quarterly contact with follow-along clients. Contact is made to offer support, and guidance, and assist them in maximizing the clients’ participation in the goal-attainment process.
• Effectively negotiate for services for clients in their communities professionally.
• Travel and provide services in client’s homes and communities
• Maintain a confidential home environment that is equipped with a reliable internet connection to facilitate remote workdays otherwise working from the office will be always required. 
• Maintains a caseload of up to 30 active clients and no more than 15 follow-along clients 
• Understand the Vendor Contract budget and prioritize the payment for services based on need, financial eligibility, and availability of resources.
• Understand the Vendor Contract for the various MCOs and the different requirements of each
• Provide education to clients, their families, and the community regarding brain injury and community resources.
• Demonstrate a commitment to person-centered services and the opportunity for clients to choose their services and providers as documented in the individualized service plan and case notes.
• Spend a minimum of 50% of their time in direct contact with clients and their families providing supportive counseling, coordination of services, resource determination, monitoring of services, and team meetings. This will be monitored through case documentation and Outlook calendar entries.
• Professionally present themselves in dress, language, questions, and comments always.
• Maintain a routine schedule, which reflects a 40-hour week but is flexible to include evening meetings. This is also monitored through the Outlook Calendar entries
• Participate in professional training particularly in the brain injury field and additional training as directed by the supervisor.
• Attend and participate in all Case Management Department meetings, Staff Professional Trainings, staff meetings, and regular one-on-one supervision with the department manager
• Other duties as directed by the Department Manager of Adult Case Management Services.

Knowledge, Skills, and Abilities: 

• Integrity, discretion, and respect for confidentiality and privacy 
• Good knowledge of Brain injury and its effects on individuals and families
• Self-directed, able to work independently with a high level of autonomy and strong problem-solving skills
• knowledge of Long-Term Case Management
• Knowledge of the Veterans Affairs system
• Knowledge of the Medicaid system and MCOs
• Knowledge of supportive counseling techniques
• Knowledge of basic medical terminology 
• Knowledge of community agencies/resources.
• Excellent oral and written communication skills and the ability to deescalate misunderstanding errors in a professional manner
• Strong technology and computer skills e.g. typing, computing, data entry, virtual video platforms (e.g. Zoom), DocuSign, and other technical skills as the job requires 
• Strong assessment and analytical skills
• Ability to prioritize work under pressure 
• Strong time management skills
• Strong organizational skills
• Strong attention to detail
• Strong spelling, math, and financial skills
• Strong documentation skills on time 

Essential Job Requirements: 

• Valid driver’s license and reliable personal transportation to travel throughout Fairfax, Arlington, City of Alexandria, Loudoun, and Prince William areas. Local travel is required
• Act as point of contact for TCM referrals 
• Physical mobility
• Ability to perform math calculations
• Ability to perform complex problem-solving and reasoning. 
• Ability to secure a telework environment at home that maintains confidentiality and professionalism
• Access to secure and reliable internet services at home for remote work option
• Ability to shift between in-person and virtual service delivery models.
• Must be able to read, write, and proofread at a professional level. 

Educational Requirements:

• Master's Degree in the human service field e.g. Social Work, Rehab Counseling, Psychology, Occupational Therapy, etc.
• Brain Injury Fundamental Training and Qualified Brain Injury Specialist training are required upon hiring.
• Certified Brain Injury Specialist training is optional after 1 year from hiring. 

Brain Injury Services offers an excellent benefits package including competitive time off plan, employer-paid healthcare and dental, life insurance, disability and retirement plan.