Description Job Purpose Enrollment Navigators (EN) help facilitate the communications and paperwork with patients/families as they are entering MHMR services. The Navigator completes enrollment activities to assist patients with intellectual and developmental disabilities (IDD) (or their LAR) to access state waiver and certain MHMR programs and services. ENs have frequent in-person contact with patients, their families, and service providers to complete required documentation by state deadlines. ENs are responsible for being knowledgeable about the services and programs our patients may be eligible for. ENs perform screening and assessment activities for those enrolling into Medicaid, the Texas Home Living program (TxHmL) and Home and Community-Based Services (HCS) program; crisis intervention activities; and service planning and coordination. ENs are the front door to services and must provide people with seamless person-centered services and support during the complicated intake, eligibility, and enrollment processes. ENs collaborate with each other, proactively communicate within and across programs and support systems, and are knowledgeable about the array of services and supports available in the community to help patients identify and prioritize their personal goals and outcomes, as well as requests for services and supports. Essential Functions Educates patients on the services they may be eligible for, ensuring the patient can make an informed decision on which program best meets their needs. EN acts as a guide to the patient as they move through the enrollments process and navigate the human services system.
- EN will attend training opportunities to remain informed on the array of programs available to the IDD population including but not limited to CLASS, STAR+PLUS Waiver, MDCP, ICF, HCS, TxHmL, and Yes Waiver.
- EN coordinates planning meetings, as needed, with program providers and/or MCO representatives to help patients understand their services options.
- EN will complete referrals to both internal and external services and resources that meet identified needs of the patient.
- If person is enrolling from the community and possible crisis indicators have been identified, EN will present patient to Cross Systems Consultation Team to discuss additional supports and ensure recommendations are followed up on and included in PDP.
EN completes outreach and enrollment activities that adhere to HHSC Performance Contract and state requirements.
- Makes initial contact to patients who have received a waiver slot within 3 days of receiving enrollment folder to coordinate an initial meeting. If EN is unsuccessful in making contact by phone, a home visit to addresses on file is required.
- Holds an initial meeting with the patient to provide oral and written explanation of the services and supports the patient may be eligible to receive in the program. If they are interested in enrolling, EN will complete the discovery tool and will review, explain, and sign all initial paperwork as required by HHSC and agency policy, including demo form for insurance verification.
- Provides current provider list to the person and may assist patients/LARs with arranging appointments. EN will complete inquiries, notify patients/LARs of upcoming provider fairs, and/or assist in developing provider interview questions. EN will explain services available through the waiver thoroughly and will use discovery process to help patient in identifying which waiver services are important to them.
- Helps and supports patient to ensure a provider is selected for the waiver program services within allowed timeframe, including contacting patient weekly during provider selection process.
- Assists in establishing eligibility into the waiver program, by completing referrals to the benefits and eligibility departments. EN will facilitate appointment scheduling, when requested, for these departments. EN will check in periodically with the patient during the Medicaid application process.
- May serve as coordinators for crisis cases to help facilitate meetings, paperwork and process.
- Maintains communication between departments, programs, and community partners so entire service planning team remains updated on enrollment process and any barriers to enrollment.
- Completes one face to face visit and three collateral contacts per month for each patient on their caseload during the enrollment process. This will include both Medicaid and non-Medicaid contacts
Develops an IPC/PDP that reflects services and supports consistent with needs, requests and preferences of person receiving services. Facilitates planning activities through the IPC/PDP process.
- Once a provider is chosen, EN coordinates an IPC (Individual Plan of Care) meeting with the patient, their service planning team, waiver provider representative, and anyone else the patient would like to be involved in the planning process.
- EN and the planning team will develop an IPC that reflects services and supports consistent with needs, requests, and preferences of the patient receiving services.
- Ensure that barriers to the person's personal goals and desired outcomes are identified and are addressed in the IPC/PDP.
- Based on the services outlined in the IPC and through the discovery process, the EN will write the PDP (Person Directed Plan) for the patient and will submit to program manager the completed plan 10 days before the start date for waiver services.
EN uses specific protocol and procedures when developing each person's: Person Directed Plan (PDP), Service Coordination Assessment (EC Assessment), Community First Choice Assessment (CFC), Transportation Plan, Individual Plan of Care (IPC), Permanency Plan (PPR), Intellectual Disability & Related Condition (IDRC) and Inventory for Client and Agency Planning (ICAP). Builds effective relationships with all stakeholders on behalf of the person being served.
- a. Ensures the family/guardian and service providers are informed of the person's goals and desired outcomes and any changes in those goals, outcomes, services and supports.
- b. Report problems with any providers to appropriate staff.
- c. Assists comprehensive provider in securing generic resources as needed.
- d. Assure that all necessary/required information is forwarded to providers in a timely manner.
Performance standards are performed as applicable with MHMR's We CARE values We Connect People in Our Community. We Provide Access to Services. We Link People to Resources. We Empower People. Performs other job duties or responsibilities as requested of assigned. Knowledge of Laws, Regulations, Policies/Procedures, Skills, and Abilities
- Intermediate Care Facilities (ICF)/ Individual Developmental Disabilities standards for enrollment
- TxHmL Standards
- HCS Standards
- Service Coordination Rule
- Medicaid enrollment and billing guidelines
- Department of Family and Protective Services (DFPS) rules regarding abuse and neglect
- MHMR policies and procedures
- HHSC Performance Contract
- Laws related to persons with intellectual and developmental disabilities or related conditions
- Rules pertaining to Medicaid and Medicaid eligibility
- Waiver Enrollment Requirement (including other waivers such as MDCP, CLASS and DBMD)
- Satori Alternatives to Managing Aggression (SAMA) Assisting and Protection
- Organizational skills
- Interpersonal skills
- Ability to understand, monitors, and apply policies and procedures
- Ability to communicate effectively orally and in writing
- Ability to work a flexible schedule
- Ability to work within a team
- Ability to prioritize
- Ability to make presentations
- Ability to work collaboratively with providers and other agencies
- Ability to use conflict resolution skills
- Knowledge of computer software
- Family codes-for serving IDD/Behavioral Health (BH) forensic population
Internal & External Customer Service This position requires internal and external contacts. The Enrollment Service Coordinator will be in contact with private and public providers. Travel Adhere to MHMR Mileage and Travel reimbursement policy and any other aspect regarding travel. Equipment Used Utilized as required for position. Minimum Requirements Minimum Qualifications Minimum Education: Bachelor's Degree Defined Education: Health/Human Services Acceptable Degrees Include: Applied Behavior Analysis, Behavioral Services field, Communication Disorders, Criminal Justice, Counseling, Education, Family Studies, Gerontology, Educational Psychology, Health Services, Human Services field, Human Growth and Development, Medicine, Nursing, Physician Assistant, Psychology, Rehabilitation, Social Services field, Social Work, Sociology, and Special Education Preferences: Service Coordination experience; experience working in community center; experience working with people with IDD Substitutions: None Years' Experience: None Defined Experience: License/Certifications: Valid Texas Driver's License Special Courses: None Supervisory Experience: None Agency RequirementsAll staff are required to participate in agency Emergency Preparedness and Environmental Safety programs and may be assigned by their department as a key/essential staff level function during critical events or for the purpose of sustaining business continuity. This position may require temporary or permanent re-assignment to any MHMR Tarrant facility as determined by program needs and/or the Division/Director. Assigned work hours may change as the needs of the agency change. The Functional Title of this position may change as the needs of the agency change. All work will be completed within the scheduled work hours. All non-exempt (hourly) employees are expected to clock in and clock out for each work shift, no work should be done off the clock. MHMR reserves the right to change, add to or eliminate positions as it deems appropriate. Employment is at will, as well as agency needs may change. Agency dress code is to be followed at all times. Physical on-site presence, including regular attendance and punctuality, is an essential function of this position. Any changes or adjustments to your assigned work schedule or shift hours must be approved by your supervisor in advance. Lifting Requirement: 15-25#Our Benefits:Our total rewards program offers benefits* to full time employees beginning 1st of the month following hire date including but not limited to: Comprehensive healthcare options (Medical, Dental, and Vision) Life insurance and additional supplemental accident and hospitalization plans 401a match and 457 deferred compensation plans Paid vacation and holidays; varied flexible work environment locations Annual tuition reimbursement program Student Loan Forgiveness Professional development programs and training And more.....Insurance eligibility: Full time employees begin 1st of the month following hire date Market driven positions (full time or part time) begin immediately after hire date Select part time market driven positions are eligible for most insurance plans Substitute status jobs are not eligible for benefitsFor more information, click Additional Information*MHMR of Tarrant County ( MHMR ) and its affiliates and subsidiaries have an internal recruiting department. MHMR may supplement that internal capability from time to time with assistance from temporary staffing agencies, placement services, and professional recruiters herein after referred to collectively as Recruiters ). Recruiters are hereby specifically directed NOT to contact MHMR employees directly in an attempt to present candidates - MHMR recruiting team or other authorized MHMR personnel must present ALL candidates to hiring managers. For more information please visit our website www.mhmrtc.org