Medicaid & Social Services Consultant II

JobAps; New Castle (DE); Hybrid; USD 65,000 - 90,000; Full time

Job summary

The Department of Health and Social Services (DHSS) in Delaware seeks a Medical/Social Services Consultant II to review MEQC cases and ensure accurate eligibility determinations. You will conduct third-party reviews, analyze data, verify eligibility factors, and prepare comprehensive reports with correction plans.

In this advanced role, you’ll supervise entries, coordinate with providers and insurers, and contribute to program planning, policy improvements, and outreach events to support

Qualifications

• Bachelor's degree or higher in Health, Behavioral or Social Science or related field.
• Two years' experience in case management across assessing, planning, developing, implementing, monitoring, and evaluating options and services to meet an individual's human service needs.
• Two years' experience in making recommendations as part of a client's service plan such as clinical treatment, counseling, or determining eligibility for health or human services/benefits.
• Two years' experience in client healthcare resource coordination and support.
• Six months experience in interpreting laws, rules, regulations, standards, policies, and procedures.
• Six months experience in narrative report writing.

Responsibilities

• Manages cases over the continuum of a healthcare delivery system for clients with complex, chronic, and specialized physiological medical conditions.
• Facilitates access to medical and social service resources across public, private, and community sectors.
• Collaborates with health care providers, services, programs, and insurance entities to develop tailored service plans and interventions.
• Integrates care and communication between stakeholders to ensure optimal health and social outcomes.
• Navigates and consults on the intersection of services, authorizations, and payments between the clients, providers, insurance programs and/or Managed Care Organizations.
• Works with providers and insurance entities to obtain pre-authorizations and referrals.
• Schedules and attends multidisciplinary evaluations and assessments.
• Facilitates and participates in discharge and transition planning.
• Formally responds to casework inquiries and investigates complaints, assessing services or eligibility against legal entitlements or contracts.
• Provides subject matter expertise through outreach and education to program staff, community members, providers, and other stakeholders through special community events or health education and preventative services.
• Advocates for community health and wellness.
• Maintains and tracks service, eligibility, and referral data sets, manages data for reporting and program planning.

Education

Bachelor's degree or higher in Health, Behavioral or Social Science or related field

Job description

The Department of Health and Social Services (DHSS) in Delaware seeks a Medical/Social Services Consultant II to review MEQC cases and ensure accurate eligibility determinations. You will conduct third-party reviews, analyze data, verify eligibility factors, and prepare comprehensive reports with correction plans.

In this advanced role, you’ll supervise entries, coordinate with providers and insurers, and contribute to program planning, policy improvements, and outreach events to support