IDD Reviewer/Case manager

IDD Reviewer is responsible for assessing and evaluating individuals with intellectual and developmental disabilities to ensure they receive appropriate services and support. This role involves reviewing documentation, conducting interviews, and analyzing care plans to verify compliance with regulations and standards. The reviewer may also assess service delivery quality, ensure proper certification and eligibility for Medicaid or other services, and provide feedback to improve care and service outcomes for individuals with IDD. The goal is to promote better quality of life and ensure that individuals with IDD receive the necessary resources and support they need.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Conducts detailed evaluations of provider performance and the presence of person-centered supports using applicable tools and guidelines.

• Initiates contact with service providers to establish interview and review schedules and discuss associated protocols, expectations, and responsibilities.

• Conducts interviews with individuals with I/DD, family members, providers of services and/or direct service staff.

• Observes the service environment, follows professional protocols to gather pertinent information and collects relevant data.

• Reviews required documentation to evaluate supports and services and gather pertinent information regarding the quality of the person-centered service delivery system.

• Administers and makes determinations based upon the information gathered from individual interviews and provider reviews in a manner that meets established proficiency standards.

• Establishes and maintains a positive and respectful approach with individuals/family members/providers/support coordinators throughout the review process.

• Uses professional judgment and discretion to determine when a report of abuse, neglect and/or exploitation is warranted or a referral to state staff is necessary to maintain the health and safety of individuals receiving services through the Medicaid Waiver program.

• Takes immediate action in the case of abuse, neglect and/or exploitation by reporting directly to required officials and follows established protocols as a mandated reporter.

• Inputs data into a web-based application, summarizes findings, generates recommendations for quality improvement and completes a written report for submission to the provider/support coordinator/contractor or other entity in accordance with pre-established timeframes.

• Captures information to determine the necessity of further survey activity.

• Participates actively and effectively in associate development activities such as conference calls, professional meetings, and annual training activities.

Qualifications

To be successful in this role, an individual must be able to effectively perform all essential duties. The qualifications listed below represent the knowledge, skills, and abilities required. Reasonable accommodations may be provided to assist individuals with disabilities in completing the essential functions.

Education and/or Experience

A Bachelorâ s degree is preferred. At least three years of experience in human services, health care, or similar fields related to quality assurance, Medicaid, certification, service delivery assessment, or related work is required, with a minimum of one year of experience working with intellectual and developmental disabilities. Exceptions may be granted with state approval. Depending on contract specifications, a specific degree or certification may be required.

Language Skills

• Ability to read, analyze, and interpret various reports, documents, and journals.

• Ability to independently respond to inquiries or concerns from clients, regulatory bodies, or the community.

• Ability to produce professional reports in a prescribed format and style.

• Ability to effectively communicate and present information to both team members and clients.

• Ability to communicate clearly and listen attentively to establish and maintain a professional environment when interacting with internal or external staff and service providers.

Benefits

After 6 months 40 hours of vacation available (1 week)

After1 year 80 hours of vacation available (2 weeks)

$30.00 per month phone subsidy.

Mileage reimbursement

NRI is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, among other things, or status as a qualified individual with disability.