Medicaid Enrollment Specialist (Long Term Care)

Job Type: Contract (12+ Months)

Job Responsibilities:

• The incumbent will be assigned to the Enrolment Unit. The Enrolment Unit is tasked with managing functions related to the eligibility and enrolment process for the Office of Long Term Living (OLTL) Fee for Service (FFS) Home and Community Based Service Programs and the Long-Term Services and Supports Managed Care Program, known as Community Health Choices.
• The Enrolment Team is tasked with management and oversight of the Independent Enrolment Broker (IEB) contract. The IEB vendor is responsible for facilitating the eligibility and enrolment process for individuals applying for Home and Community Based Service Programs administered through OLTL which currently include the Home and Community Based Waiver programs (Community HealthChoices Waiver and OBRA Waiver), the Act 150 Program and LIFE Program. The enrolment services vendor will be responsible for managing enrolments and plan transfers into OLTL's managed care programs, nursing
• facilities, and other Beneficiary Support Services to ensure that quality, effective and efficient services are provided to participants in their communities.
• As a member of the Enrolment Unit, the incumbent will be primarily responsible for:
• Review and analyse Operational Reports received from the IEB Vendor and the CHC Managed Care Organization for monitoring of contract requirements.
• Complete performance reviews to determine contract compliance and recommend actions to correct any findings of non-performance.
• Assist in the development, implementation and maintenance of tracking and reporting systems for monitoring contract compliance and vendor performance.
• Respond orally and in writing to enrolment and eligibility inquiries received from the Office of Legislative Affairs, and other Offices.
• Use established regulations, policies and procedures to provide guidance and technical assistance to the Independent Enrolment Broker (IEB), service coordinators, Managed Care Organizations, and other stakeholders in regard to the eligibility and enrolments process.
• Review and analyse daily, monthly and quarterly reports that identify records with issues/errors that prevent enrolments into an OLTL LTSS program. Issues/errors include, but are not limited to, records with open facility and waiver codes, ineligible citizenship codes, open enrolments with another program office, inter county transfers, FFS to CHC transfers etc. The incumbent will confirm the issue and complete follow up with appropriate agency or program office including the IEB, SC agencies, MCOs, OMAP Bureau of Data and Claims Management, Office of Income Maintenance, the LIFE Program and others appropriate.
• Participate in hearings for appeals related to program eligibility determinations and other eligibility and enrolments appeals as required.
• Develop and prepare weekly reports of all tasks and activities.
• Use specialized databases such as, but not limited to, Client Information System (CIS), PROMISe, Home and Community Services Information System (HCSIS), Social Administration Management System (SAMS), to ensure enrolments are completed per established regulations, standards and requirements.
• Provide technical assistance, policy/procedural and regulatory interpretation to providers; advise supervisor of problems and unusual incidents as appropriate.
• Serve on workgroups, comprised of staff from within OLTL or stakeholders from outside OLTL. Committee work may include evaluating policy recommendations, directives and regulations; and assisting with the development of operational manuals, program directives, work plans, system changes, regulations, policies and procedures regarding the eligibility and enrolments process.
• Attend and participate in team meetings, division meetings and bureau meetings as scheduled.

Qualifications:

• Bachelor's degree in social work, human services or related areas preferred from an accredited college or university and at least two years' experience providing working knowledge of Medicaid home and community-based services, and long-term care services.
• Experience and proficiency in use of Microsoft office with an emphasis on Microsoft Excel
• Strong interpersonal skills for working with contract vendor, agency and other professional personnel
• Ability to learn and apply Commonwealth procedures and regulations and standard business practices related to the operations of the contract.
• Demonstrated ability for written and oral communication, and program development responsibilities.
• Strong organizational skills with attention to details and a demonstrated ability to work independently under general supervision.
• Public speaking experience is desirable.
• Telework eligible.

22nd Century Technologies, Inc. (TSCTI) is one of the fastest-growing IT Services Integrators and Workforce Solutions providers in the United States. Founded in 1997, TSCTI is a Certified National Minority Business Enterprise (MBE) with a workforce of 6,000+ professionals, including 600+ Cybersecurity Subject Matter Experts (SMEs), delivering mission-critical solutions across all 50 U.S. states, Canada, and Mexico.

Headquartered in Princeton, NJ, and McLean, VA, with 14 regional offices nationwide, TSCTI provides comprehensive solutions in Digital Transformation, Artificial Intelligence (AI), Cybersecurity, Cloud Computing, IT Infrastructure, Enterprise Modernization, DevSecOps, Managed Services, Workforce Solutions, and Healthcare Staffing. We are a trusted partner to Federal, State, Local, Education (SLED), Healthcare, and Commercial organizations, delivering innovative technology and talent solutions that enable our clients to achieve their strategic objectives.

As one of the nation's leading Healthcare Workforce Solutions providers, TSCTI supports federal healthcare systems, Veterans Affairs (VA) Medical Centers, state and local healthcare agencies, hospitals, clinics, laboratories, long-term care facilities, and commercial healthcare organizations. We recruit and place highly qualified healthcare professionals across a wide range of specialties, including physicians, advanced practice providers, registered nurses, allied health professionals, behavioral health specialists, laboratory personnel, pharmacy professionals, and healthcare administrative staff. Our healthcare solutions ensure continuity of care while maintaining the highest standards of clinical excellence and regulatory compliance.

With a strong commitment to quality and compliance, TSCTI operates through CMMI Level 3 (Development & Services) and ISO 9001, ISO 20000, and ISO 27001 certified processes, ensuring consistent service excellence, operational maturity, and information security. Today, we proudly support 14 of the 15 Federal Executive Departments, 37 Federal agencies, 50 State governments, 115+ Local agencies, 37 School Districts, numerous healthcare organizations, and 80+ Fortune 500 and commercial clients.

TSCTI has earned numerous industry recognitions, including being named among Forbes America's Best Large Employers, Forbes Best Employers for Veterans, Forbes Best Employers for Tech Workers, Newsweek's America's Greatest Workplaces for Diversity, and a 13-time Inc. 5000 honoree. The company has also been recognized by the Washington Business Journal as one of the Best Places to Work and continues to expand its capabilities through strategic innovation, acquisitions, and investments in emerging technologies.

At TSCTI, our people are our greatest strength. We are committed to fostering an inclusive, collaborative, and growth-oriented workplace where innovation thrives and careers flourish. Whether delivering cutting-edge technology solutions or connecting exceptional talent with meaningful careers, we consistently exceed our clients' expectations while empowering our employees to succeed.

Equal Opportunity Employer

22nd Century Technologies, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.