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Department:

Department of Social Services (DSS)

Division:

Economic Services -

Family Medicaid FLSA Status:

Exempt Pay Grade:

Reports To:

Economic Services Program Administrator or Social Services Program Manager General Statement of Duties Performs advanced professional, administrative, and supervisory work directing the daily operations of the Family Medicaid unit within the Department of Social Services. The employee supervises Economic Services Caseworkers and support staff responsible for determining eligibility for Family Medicaid and related Medicaid programs in accordance with federal and state regulations. Responsibilities include planning, organizing, assigning, reviewing, and evaluating staff performance while ensuring compliance with all applicable North Carolina Department of Health and Human Services (NCDHHS), Division of Health Benefits (DHB), county, and program policies. The supervisor monitors productivity, accuracy, timeliness standards, quality assurance, customer service, and program integrity while promoting efficient and accessible service delivery to McDowell County residents. The following duties are representative and are not intended to be all-inclusive. Supervision and Leadership Supervises Economic Services Caseworkers, Processing Assistants, and other assigned personnel. Assigns, prioritizes, and monitors workloads to ensure timely processing of Medicaid applications, recertifications, changes, and other case actions. Conducts performance evaluations and provides coaching, mentoring, and corrective action when appropriate. Assists with recruitment, interviewing, onboarding, and training of new employees. Develops work schedules and approves leave requests. Conducts staff meetings and communicates program updates, policy changes, and operational expectations. Provides guidance and technical assistance to staff regarding complex eligibility issues. Promotes consistent application of Medicaid policies and procedures among assigned staff. Program Administration Oversees the administration of Family Medicaid and related Medicaid programs assigned to the unit. Ensures compliance with federal and state Medicaid regulations, NCDHHS/DHB policies, and county procedures. Reviews complex eligibility determinations and resolves difficult or unusual cases. Monitors application processing, recertification, change reporting, and other required case actions to ensure compliance with established timeliness standards. Ensures accurate and complete documentation within NC FAST. Assists staff with interpretation and implementation of changing Medicaid policies, procedures, and eligibility requirements. Coordinates implementation of new policies, procedures, system changes, and program initiatives. Monitors workload and staffing levels and makes recommendations regarding resource allocation. Quality Assurance and Compliance Performs quality control and supervisory reviews of case records. Identifies trends in errors, deficiencies, or processing issues and develops corrective action plans. Monitors state performance reports, accuracy measures, timeliness standards, and county performance indicators. Responds to quality assurance findings and develops strategies for improvement. Ensures appropriate documentation and case maintenance practices. Ensures confidentiality and security of protected health, financial, and client information. Assists with state monitoring visits, reviews, audits, and corrective action activities. Promotes program integrity and compliance with Medicaid eligibility requirements. Customer Service Handles escalated client concerns and complaints. Provides guidance to staff regarding difficult or sensitive client situations. Serves as a liaison with healthcare providers, community agencies, advocacy organizations, and other partner agencies as appropriate. Provides information regarding Medicaid eligibility policies and procedures within the scope of the position. Promotes professional, respectful, and timely customer service standards throughout the unit. Assists in resolving barriers that may prevent eligible individuals and families from accessing Medicaid services. Administrative Responsibilities Prepares reports, statistical data, and other information related to Family Medicaid operations. Monitors staffing needs, workload distribution, productivity, and case processing performance. Recommends policy and procedural improvements. Assists with planning and implementation of program-related initiatives. Participates in county committees, leadership meetings, state training sessions, and other meetings as assigned. Maintains appropriate records and documentation related to unit operations. Assists management with identifying training needs and developing staff development activities. Knowledge, Skills, and Abilities Comprehensive knowledge of: Federal and State Medicaid laws, regulations, policies, and procedures. North Carolina Economic Services policies and procedures. NC FAST eligibility and case management systems. Medicaid eligibility requirements and income maintenance principles. Family Medicaid programs and related public assistance programs. Supervisory principles and employee performance management. Quality assurance and program integrity standards. Public assistance program administration. State and federal confidentiality and privacy requirements. Principles and practices of effective customer service.

Ability to:

Interpret and apply complex federal and state Medicaid regulations and policies. Supervise, train, coach, and motivate employees. Analyze complex eligibility situations and make sound decisions. Review case records for accuracy, completeness, and compliance. Monitor performance data and identify areas requiring improvement. Prepare reports and maintain accurate records. Communicate effectively both orally and in writing. Build positive working relationships with staff, clients, healthcare providers, and community partners. Handle stressful, sensitive, and high-volume situations with professionalism. Exercise sound judgment and independent decision-making. Adapt to frequent changes in Medicaid policy, procedures, and technology. Minimum Education and Experience Option I Bachelor's degree from an accredited college or university in Social Work, Sociology, Psychology, Human Services, Business Administration, Public Administration, or a closely related field and Three (3) years of experience as an Income Maintenance Caseworker II, Income Maintenance Caseworker III, or equivalent eligibility position, including one (1) year of lead worker or supervisory experience. OR Option II Graduation from high school and five (5) years of progressively responsible experience determining eligibility for public assistance programs, including at least two (2) years of experience in Medicaid eligibility determination and one (1) year of supervisory or lead worker experience. Equivalent combinations of education and experience may be considered in accordance with applicable state minimum qualifications. Preferred Qualifications North Carolina Income Maintenance Caseworker certification. Supervisory experience within a county Department of Social Services. Extensive experience using NC FAST. Experience with Family Medicaid and related Medicaid programs. Experience with Medicaid quality assurance and performance monitoring. Knowledge of

NCDHHS/DHB

Medicaid policies and performance standards. Experience conducting staff training and providing technical assistance. Experience handling complex Medicaid eligibility cases and escalated client concerns. Special Requirements Valid North Carolina Driver's License. Ability to travel for required training, meetings, conferences, and other official county or state business. Successful completion of required state and county training. Background investigation as required for county employment. Physical Requirements The work is primarily sedentary and requires: Sitting for extended periods. Frequent use of computers and office equipment. Occasional standing, walking, bending, and lifting up to 20 pounds. Ability to communicate effectively with employees, clients, healthcare providers, and the public. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions. Working Environment Work is performed primarily in an office environment with frequent interaction with employees, clients, healthcare providers, community agencies, and the public. The position requires managing multiple priorities, meeting strict federal and state deadlines, maintaining confidentiality of sensitive client information, and responding appropriately to policy changes, system issues, emergency program changes, and high-volume workloads. Performance Expectations Success in this position is measured by: Compliance with federal and state Medicaid regulations and

NCDHHS/DHB

policies. Timely and accurate processing of Medicaid applications, recertifications, and case actions. Unit accuracy and quality assurance performance. Staff productivity, development, and performance. Effective workload management. Positive customer service outcomes. Achievement of county and state performance measures. Effective leadership, communication, and teamwork. 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Find & Apply For Enrollment / Eligibility Specialist Jobs in Marion, North Carolina

Economic Services Supervisor-Family Medicaid