Case Manager

Duties

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 (HBX). The mission of the HBX is to implement a health care exchange program in the District of Columbia in accordance with the Patient Protection and Affordable Care Act (PPACA), and the Health Benefit Exchange Authority Establishment Act of 2012, thereby ensuring access to quality and affordable health care to all District of Columbia residents.

MAJOR Duties

Assesses eligibility for enrollment and providing enrollment assistance in DC Health Link insurance products and Medicaid for individuals and families who have applied for or have had difficulty in accessing insurance information through the on-line insurance marketplace.

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

Attends community meetings, workshops and special programs to disseminate information to District residents about DC Health Link programs and services.

Interfaces with community-based in-person assisters, federally qualified health centers, navigators and key stakeholder groups regarding case management services available for residents unable to enroll in insurance programs on their own.

Assist with identifying and communicating any change in Exchange eligibility and enrollment policies, federal or local regulations to residents seeking to enroll in various health insurance products.

Attend meetings and seminars on issues related to health insurance, health care reform, Medicaid, etc. that may impact eligibility, enrollment, tax credit eligibility, denial of coverage and appeals in the Health Benefit Exchange.

Responds to crisis situations, and attempts to resolve enrollment problems for individuals and families.

Participates in conferences, educational training and workshops, and remains fully informed in matters of the ACA and its implementation.

Maintains statistical data and updates case records which reflect current and accurate data of individuals and families served and the case management activities performed.

Answers correspondence from the public in reference to enrollment issues.

Completes reports and makes recommendations to HBX leadership for changes in enrollment procedures, as needed, to better serve consumers.

Performs other related duties as assigned.

KNOWLEDGE REQUIRED BY THE POSITION

Knowledge of health coverage programs and eligibility (including Medicaid), operations, and policy required. Knowledge of rules governing and compliance with the Health Insurance Portability and Accountability Act (HIPAA) and the confidentiality of consumer information.

Skill in interviewing consumers, within the context of cultural competency considerations, in order to gather information pertinent to case services and resolutions or to facilitate escalation to HBX leadership for closure.

Knowledge of, and skill in applying analytical, investigative and evaluative methods and techniques to conduct research, resolve problems, gather information, analyze and evaluate information/data.

Ability to complete assignments/projects on time, prioritize multiple tasks, prepare work plans, and proactively seek out guidance on related project issues.

Ability to effectively communicate orally and in writing, in order to provide assistance to clients; to prepare reports; and to maintain contact with community, resource groups, and collaborative organizations.

SUPERVISORY CONTROLS

The incumbent works under the general direction and administrative guidance of the Consumer Services Manager, who makes assignments and is available for policy guidance. The incumbent independently plans and carries out the assignments, resolving most conflicts that arise, but consults supervisor on controversial and

complicated cases. Completed work is reviewed from the standpoint of effectiveness of casework and support services provided in addition to meeting expected results.

GUIDELINES

Principal guidelines include: established District of Columbia laws, regulations, policies, and procedures, including HBX regulations, policies, and procedures; pertinent federal laws, regulations, policies, and procedures; and specific instructions from the Executive Director. Guidelines also include accepted public health and insurance principles and practices and authoritative guidance issued by the Center for Consumer Information and Insurance Oversight (CCIIO), and the Centers for Medicaid and Medicare Services (CMS). Incumbent exercises judgment and initiative in carrying out assignments, as well as interpreting and adapting guidelines to specific situations.

COMPLEXITY

Provides a wide range of case management services to individuals who have specific needs based on various environmental realities including: health status, family composition, fluctuating income and/or employment status. Gathers and disseminates information and contacts collateral sources to obtain information.

Confers with officials, representatives of other District government agencies to resolve issues which serve as barriers to insurance enrollment. Also develops resources and contacts. Consumers may have a multiplicity of needs, such as family member with no or widely varying incomes, proof of identity, and/or validation of income. The solutions for assistance may require the incumbent to prioritize those needs individually, or in a team approach, addressing numerous problems simultaneously.

SCOPE AND EFFECT

The purpose of the work is to perform the full range of case management services to individuals and families seeking to enroll in insurance products sold through the DC Health Benefit Exchange's on-line marketplace, "DC Health Link.com". This includes assistance in determining eligibility for private insurance, public insurance such as Medicaid, income verifications, identity proofing, and determining eligibility for tax credit assistance to lower the cost of insurance. The scope of the work extends from case referrals/assignment to case management by providing support services to consumers unable to obtain health insurance. The work has an impact on the overall service delivery capability of the Health Benefit Exchange, and ultimately the consumers who need assistance.

PERSONAL CONTACTS

Contacts are with community-based In-Person Assister organizations, DHS/ESA staff, DCAS Project Team members, individual consumers and their family members, and other DCHBX team members working on eligibility and enrollment issues.

PURPOSE OF CONTACTS

The purpose of these contacts is to secure information necessary to provide and evaluate services, and to provide advocacy for consumers, and to ensure that they receive quality services. Contacts with representatives of other agencies are for the purpose of providing and exchanging information to assist in the consumer enrollment process.

PHYSICAL DEMANDS

The work requires some field work and may require extended hours.

WORK ENVIRONMENT

This work is performed primarily in an office setting and may require field work at DHS/ESA Centers or other locations around Washington where residents seek benefits assistance.

OTHER SIGNIFICANT FACT

This position requires a Bachelor's Degree; or an equivalent combination of education, training and experience.