MEDICAL CARE PROGRAM ELIGIBILITY SUPERVISOR

Job Specifications

Class Code:

SE2 

Analyst: 

RM/CJS 

Date Originated:

2/84 

Date Revised:

 12/07

SANTA CRUZ COUNTY

DEFINITION

Under direction, to supervise subordinate staff and to plan and organize program activities in the indigent medical care eligibility program or California Children’s Services eligibility program; to develop eligibility criteria and procedures according to California Children’s Services policies or the County's indigent medical care policies; to monitor the eligibility program for efficiency and cost-effectiveness; and to do other work as required.

DISTINGUISHING CHARACTERISTICS

This is a first level supervisory class with responsibility for developing and implementing an eligibility program for the County’s indigent medical care program or California Children’s Services program. The incumbent supervises a subordinate staff performing eligibility determination, verification, writing authorizations for services and related clerical support activities. The class differs from other eligibility supervisors by the assignment of independent responsibility for program and procedure development.

TYPICAL TASKS

Develops indigent medical eligibility program regulations; writes manuals and prepares policy guideline memoranda; designs format and content of forms unique to medical programs; ensures that eligibility criteria are consistent with established policy and regulatory mandates; originates procedures to gather and compile program statistics and detect potential sources of error or overpayment in the eligibility determination process; trains and supervises program eligibility staff; selects new employees, assigns workload, monitors progress, assists on complex cases, ensures consistency of regulatory interpretation and evaluates performance; monitors Social Security Disability Supplemental Income, State Disability, Worker's Compensation and MediCal programs and regulations and adjusts Medi-Cruz program regulations as appropriate; ensures that program maximizes available payer sources and does not duplicate eligibility requirements by screening qualified applicants for referral to other public or private health insurance or income resources; prepares recommendations to enhance program efficiency and cost-effectiveness for review by administrator; evaluates the effectiveness of eligibility determination relating to accessing care; communicates with health clinics, specialty providers and inpatient facilities concerning patients’ eligibility for coverage; resolves complaints; conducts or supports the County position in fair hearings; expedites treatment authorizations for immediate patient care as necessary; makes informational presentations on program eligibility and services to other County staff, provider organizations and community groups; maintains applicant and program statistics on computerized reporting system.

EMPLOYMENT STANDARDS

Knowledge:

  • Thorough knowledge of standard procedures and criteria for eligibility determination;
  • Thorough knowledge of public medical care assistance programs;
  • Thorough knowledge of interviewing techniques for obtaining factual information;
  • Working knowledge of principal public assistance eligibility programs;
  • Working knowledge of principles of supervision, training and workflow organization;
  • Working knowledge of the functions and services provided by public health and social services agencies;
  • Working knowledge of community medical resources;
  • Working knowledge of statistical record keeping practices;
  • Some knowledge of medical social services techniques and practices.

Ability to:

  • Interpret and apply complex regulations, laws and directions pertaining to medical care programs; 
  • Supervise and evaluate subordinate eligibility and clerical staff; 
  • Develop and apply program procedures, directions and policy memoranda; 
  • Design forms to record client information and determine eligibility; 
  • Analyze data and recommend program revisions to comply with State and Federal disability program mandates; 
  • Establish a cooperative working relationship with subordinates, County staff, service providers, clients and the public; 
  • Communicate effectively both orally and in writing; 
  • Analyze problem situations and adopt appropriate resolutions; 
  • Prepare reports and correspondence; 
  • Interpret medical care programs to applicants, recipients and providers.

Training and Experience: Any combination of training and experience that would provide the required knowledge and abilities is qualifying. Typical ways to acquire the knowledge and abilities would be:

Training in medical eligibility determination in a public assistance program;

AND

Two years progressively responsible experience as a supervisor or lead-worker performing eligibility determination and analyzing eligibility systems for health or social service programs.

Bargaining Unit: 41
EEOC Job Category: 03
Occupational Grouping: 64
Workers' Compensation Code: 0053