<p>Job Responsibilities</p> <p>The Agency's mission is to be boldly innovative in improving the health and quality of life for South Carolinians.</p> <p>This is position is located in EEMS Policy, Process & Contract Management, Statewide.</p> <p>This is an in-office role and not a telecommute or remote position.</p> <p>Are you the One? We are looking for a Program Coordinator II (EEMS Escalations Supervisor (LTC)) who, under limited supervision, will be responsible for the management of the Long Term Care (LTC) Escalations team. This position oversees the TIER II Escalation Specialists, Senior Workers, Team Leads and Escalation Coordinator I. Supervises the Tier I Escalation Specialist by way of the Program Coordinator I. Also, serves as a back-up to the Eligibility, Enrollment, and Member Services (EEMS) Escalations Long Term Care (APS LTC) Supervisor. Provides status response of eligibility policy, process, and eligibility determination system teams on issues for agency stakeholders. Provide technical assistance and support to troubleshoot and to offer solutions presented by systems use, communicates with state systems developers regarding identified systems issues, and collaborates as necessary to create job aids for training.</p> <ul> <li> <p>Leads Long Term Care Escalations teams to ensure operations and decisions comply with agency Medicaid policy and procedures and federal and state regulations. Interprets, analyzes, and ensures compliance with program policies and procedures. Resolves or collaborates with intra agency partners to resolve complex beneficiary or provided related issues. Takes full ownership of escalated cases to ensure a timely and accurate resolution. Ensures escalated cases are researched, assigned for processing, and a timely and accurate response is rendered.</p> </li><li> <p>Completes and/or assigns Service Manager Tickets in a timely manner and provide responses to each ticket per intra-agency stakeholder. Works with Helpdesk, agency wide policy team, Managed Care Organizations supporting the Bureau of Managed Care, and other intra-agencies bureaus to resolve Service Manager tickets. Collaborate with Policy Team to support and assess complex situations and cases. Responds to member and constituent inquiries or referrals by telephone, email, or written form to Non-MAGI and Long-Term Care related programs. Review and respond to Escalation inquiries received from Civil Rights, Office of Appeals, Eligibility Determination Respondent, Member Services and Member Contact Center Escalations. Accountability of unresolved inquiries from Executive Leadership, Providers and all intra-agency Bureaus to ensure timely and accurate resolution. Monitors, processes and resolves monthly Community Long Term Care report. Resolves Federal Citizenship and Immigration monthly file. Ensures data integrity to support reduction in wasted tax dollars via resolving, Federal Citizenship and Immigration, and Residency files. Ensure accurate and timely processing related to Long Term Care Medicaid to include but not limited to Cost of Living Allowance, Notice of Admission, Authorization and Change of Status and Cost of Care. Supports the Bureau of Provider and Support Services by supplying verification for timely filing.</p> </li><li> <p>Identifies, establishes, and oversees operational standards, performance goals, priorities, and operating procedures for all eligibility divisions within Escalations. Works to maximum efficiencies, effectiveness, and compliance within agency directives and determines equitable and manageable distribution of workload for program/units. Develops, creates, and maintains high quality customer service standards and ensures staff respond timely to meet the needs of Executive Leadership, Providers, applicants, beneficiaries, and customers. Works closely with Member Relations, Community, Long Term Care, Provider Service Center, Managed Care Organization, Appeals, and Eligibility, Enrollment Member Works with Leadership to address complaints, re-determinations and improve client service experience and outcomes. Provides regular and ad hoc reporting to advise leadership of trends and findings, addresses federal standards of promptness guidance, and monitor individual and units/programs production. Collaborate and streamlines with stakeholders and state agencies to ensure all expectations are meet.</p> </li><li> <p>Performs fundamental supervisory and leadership functions in accordance with Department policies and procedures, best practices, and Federal and State rules and regulations, especially with regards to Equal Employment Opportunity Commission (EEOC) standards. Maintains an effective organizational team and motivates diverse staff to accomplish mission critical operations and objectives. Promotes workforce engagement and is responsible for the personnel activities within the Long Term Escalation team. Collect, analyze, track data and develop reports for management outlining the effectiveness of program area, team determination rates, attendance trends and support for process improvements. Directs, manages and coordinates all Long Term Care Escalation personnel activities to ensure accountability, appropriateness and accuracy of personnel issues. Reviews and assists with identifying staff needs, workforce development opportunities and forecasting training opportunities for staff within the Long Term Care Escalation Team.</p> </li><li> <p>Performs other duties as assigned. Attends meetings/trainings, and assists Program Manager, Bureau Chief, and Deputy Director with special projects and files. Occasional travel offsite required.</p> </li></ul> <p>The South Carolina Department of Health and Human Services offers an exceptional benefits package for FTE and TGE positions that includes:</p> <ul> <li>Health, Dental, Vision, Long Term Disability, and Life Insurance for Employee, Spouse, and Children. </li><li>15 days annual (vacation) leave per year. </li><li>15 days sick leave per year. </li><li>13 paid holidays. </li><li>State Retirement Plan and Deferred Compensation Programs. </li></ul> <p>Minimum and Additional Requirements</p> <p>A bachelor's degree and at least four (4) years of Medicaid related experience. Experience in management and/or leadership roles required.</p> <p>An equivalent combination of education and experience may be considered with prior State Human Resources approval.</p> <p>PREFERRED: At least four (4) years working in Medicaid related programs. Extensive knowledge of the Medicaid Program, human services program, or case processing preferred.</p> <p>Additional Requirements:</p> <ul> <li>Valid driver's license. </li><li>Requires holder to drive routinely. </li><li>Occasional overnight travel. </li><li>Overtime and/or weekend work with Deputy approval. </li><li>Sitting or standing for long periods of time. </li><li>Lifting requirements: 20 lbs. </li><li>In-office role. </li></ul> <p>Preferred Qualifications</p> <ul> <li>Supervisory and/or Management experience required. </li><li>Higher skillset to analyze and interpret broad health and human escalated service case and provider issues and their impact on the Department's programs. </li><li>Extensive knowledge of laws, regulations, policies and procedures relevant to the area of employment. </li><li>Ability to exercise judgment and discretion. </li><li>Ability to establish and maintain effective working relationships with internal and external stakeholders. </li><li>Ability to effectively manage time and prioritize escalated tasks and departmental and agency projects with competing and/or shifting deadlines. </li><li>Must be able to lead and manage a diverse staff. </li><li>Ability to communicate and collaborate with staff and external stakeholders from different levels of workforce. </li></ul> <p>Additional Comments</p> <p>Please complete the State application to include all current and previous work history and education. A resume will not be accepted nor reviewed to determine if an applicant has met the qualifications for the position. Supplemental questions are considered part of your official application for qualification purposes. All applicants must apply online. All correspondence from the Office of Human Resources will be through electronic mail.</p> <p>The South Carolina Department of Health and Human Services is committed to providing equal employment opportunities to all applicants and does not discriminate on the basis of race, color, religion, sex (including pregnancy, childbirth or related medical conditions, including, but not limited, to lactation), national origin, age (40 or older), disability or genetic information.</p>