Case Management Coordinator

DCHBX Social Justice Values Statement

We believe in social justice and the power of diversity, equity, and inclusion, and are committed to fighting longstanding discrimination, racial injustice, and systemic racism to contribute to a more just and equitable future for our workforce, our customers, and our partners.

Introduction

This position is in the District of Columbia Health Benefit Exchange Authority (DCHBX). The mission of the Health Benefit Exchange Authority is to implement a health care exchange program in the District of Columbia in accordance with the Patient Protection and Affordable Care Act (PPACA) of 2010 and the District of Columbia Health Benefit Exchange Authority Establishment Act of 2011, thereby ensuring access to quality and affordable health care to all District of Columbia residents.

This position functions as Case Management Coordinator, responsible for coordinating and implementing a comprehensive and intensive case management program to establish, enforce, and or audit enrollment assistance provided by DC Health Link Case Managers in both private insurance products and Medicaid for individuals and families who have applied for or have had difficulty in accessing insurance information through the online insurance marketplace.

Duties and Responsibilities

Serves as an expert case manager in the quality assurance review process, providing technical guidance to ensure expeditious and proficient processing of cases. Conducts or participates in complex case conferences to identify and address client barriers to obtain insurance coverage, and to recommend a plan of action to address concerns. Follows up on plans of action. Presents special and unresolved cases to the supervisor.

Initiates and establishes contacts with collateral resources within the DCHBX, such as the Eligibility and Enrollment team; legal agency staff; community-based In-person Assister organizations, and insurance carriers to identify and help resolve enrollment barriers.

Is responsible for conducting training for Case Managers, supervisory staff, and program managers on new and proposed rules, policies, and procedures being implemented by the Center for Medicaid and Medicare (CMS) governing the operations of online insurance marketplaces such as DC Health Link. Also, provides training on record keeping documentation, policies or protocols, and service coordination among other agencies within the Health and Human Services Cluster.

Coordinates the preparation of case records for appeals of eligibility determinations resulting in denials of coverage. Reviews, evaluates, and prepares draft summaries to support the recommended course of action on assigned cases in accordance with procedures established by the Eligibility and Appeals Unit.

Reviews and ensures that statistical data and case records reflect current and accurate data of clients.

Qualifications and Education

Specialized Experience Experience that equipped the applicant with the particular knowledge, skills, and abilities to perform the duties of the position successfully, and this is typically in or related to the work of the position to be filled. To be creditable, at least one (1) year of specialized experience must have been equivalent to at least the next lower grade level in the normal line of progression for the occupation in the organization.

Licenses and Certifications

None


Working Conditions/Environment

Work is generally performed in an office setting.


Promotion Potential

No known promotion potential.

Other Significant Facts

Tour of Duty: Monday - Friday 8:15 a.m.- 4:45 p.m.

Duration of Appointment : Career Service Term (Not to-Exceed 13 months)

Pay Plan, Series, Grade: CS-101-13


Collective Bargaining Unit: This position is not a part of a collective bargaining unit.

Position Destination: This position has been deemed Security Sensitive under the guidelines of the DC Personnel Manual. Incumbents of this position are subject to enhanced suitability screening pursuant to Chapter 4 of the DC personnel regulations. Accordingly, incumbents must successfully pass a criminal background and consumer credit check as a condition of employment and will be subject to periodic criminal background checks for the duration of their tenure.

EEO Statement: The District of Columbia Government does not discriminate or retaliate in employment on the basis of race, color, religion, sex, pregnancy, gender identity and expression, national origin, family responsibilities, political affiliation, sexual orientation, marital status, homeless status, disability, genetic information, age, membership in an employee organization, participation in a legally protected activity, parental status, matriculation, personal appearance, credit information, status as a victim or family member of a victim of domestic violence, sexual offense, or stalking, military service, or other non-merit factor.