Computer Skills, Content Management Systems (CMS), Contract Management, Corporate Compliance, IP Multimedia System (IMS), Incident Management, Licensed Practical Nurse/Licensed Vocational Nurse, Maintain Compliance, Managed Care, Medicaid, Microsoft Excel, Microsoft Outlook, Microsoft Word, Organizational Skills, Provider Contracting, Regulations, Team Player, Time Management
Summary:
Location: Candidates can reside anywhere but must have knowledge of Ohio’s MyCare Waiver WITH OH LICENSE
Duration: 6 months, possible extension and/or conversion
Work Mode: Fully remote
Shift: Mon-Fri 8am-5pm EST – No OT unless needed – No weekends/holidays
Responsibilities:
- Develop, implement, resolve, and oversee waiver incident reporting at both member and organizational levels.
- Provide waiver incident reporting education, conduct incident investigations, and ensure incident processing and closure.
- Ensure compliance with the company's Three-Way and Provider Contract, Ohio Administrative Code, and CMS regulations.
- Identify critical incidents for Medicaid and MyCare members and ensure timely submission into the Ohio Department of Medicaid Incident Management System (IMS).
- Work with care coordination teams to create person-centered prevention plans for member safety and welfare.
- Monitor the incident mailbox, triage incidents, and forward emails related to open cases.
- Review the Critical Incident Report daily, assign cases, and maintain the internal tracking sheet.
- Follow all MyCare Waiver and MyCare SRS cases and upload documents into the IMS system.
- Maintain frequent contact with team members, providers, and partners via phone, email, and fax.
Requirements:
- Degree and/or certificate/licensure required in Nursing, Social Work, or Counseling.
- Must have an Ohio licensure as an LPN, SWA, CHW, LSW, or LPC.
- Minimum 2 years of experience in managed care with knowledge of Ohio’s MyCare Waiver & OH incident reporting.
Preferred Skills:
- Proficient in computer use and ability to navigate between programs seamlessly.
- Strong critical thinking skills.
- Experience with Excel, Word, Outlook, and Teams.
A
Axelon Services Corporation