Long Term Services & Supports Access Coordinator (Primarily Remote, North Carolina Based)

The LTS Access Coordinator is the main point of contact for inquiries about Alliance Health related to eligibility for IDD and TBI services and supports. The LTS Access Coordinator gathers all documentation of an Intellectual and Developmental Disability and/or TBI, educates callers about services available through Alliance and its network, assesses needs based on eligibility criteria for services to which callers could be potentially referred services and explains the waiting list process for needed services, including Innovations and TBI Waivers. LTS Access is the entry point for eligibility reviews and Innovations and TBI Waiver waitlists and enrollment.

This position is primarily full-time remote. Selected candidate must reside in North Carolina and be willing to travel to the Alliance office for onsite meetings if needed.

ESSENTIAL FUNCTIONS AND DUTIES

LTS ELIGIBILITY REFERRALS

• Receive referrals and inquiries from internal stakeholders, individuals, families, and providers regarding eligibility for I/DD and TBI Supports
• Assist individuals, families, and providers in understanding the eligibility and referral process
• Assist individuals and familied interested in TBI or IDD services to establish eligibility for services and the Innovations and TBI Waiver lists
• Provide information about the Waivers and eligibility as well as resources for individuals not enrolled in services
• Review available documentation for eligibility determination
• Support members in gathering needed documentation to determine eligibility for TBI and I/DD services
• Determine eligibility for members whose documentations directly supports criteria for the population eligibility requirements
• Review and presents supporting documentation to the IDD and TBI eligibility review committee as needed
• Refer reviews to the medical team for members whose eligibility is complex or unclear
• Inform members of the outcome of the eligibility review process, including providing waitlist date or adverse decision letters and resources both telephonically and via US Mail
• Communicate appropriate issues needing resolution to LTS Access Coordinator Supervisor
• Enter grievances from callers and work to resolve concerns
• Demonstrate understanding of UM due process, appeals regulation, various insurance limits and coverage relating to IDD and TBI services and fields questions and provides support to callers

WAITLIST MANAGEMENT AND WAIVER ENROLLMENT

• Maintain the Registry of Unmet Needs for the Innovations Waiver and the Registry of Interest for the NC TBI Waiver
• Maintain the Innovations Waiver Waitlist and TBI Registry of Interest, including updating information about members to support Alliance …