Job Specifications

COUNTY OF SANTA CRUZ

Under general supervision, determines financial and residential eligibility of applicants to the California Children's Services Program for diagnosis and treatment of medical conditions or disabilities; manages assigned caseload; and does other work as required.

California Children Services Specialists I/II are responsible for determining initial and ongoing financial and residential eligibility for medical care and rehabilitation of physically challenged children. Incumbents provide ongoing coordination of assigned cases by arranging care with specialists, coordinating appointment schedules and monitoring clients' adherence to treatment plans. Incumbents are expected to exercise initiative and resourcefulness in locating other medical assistance programs for which clients may be qualified, in order to facilitate cost containment. Incumbents work under the supervision of a Public Health Program Manager and may assist in training other California Children's Services Specialists. California Children's Services Specialist I/II differs from the classification of Medical Care Eligibility Worker in that the latter's primary function is eligibility determination, whereas the former determines eligibility and provides ongoing monitoring of individual cases and requires a specialized knowledge of medical terminology.

California Children Services Specialist I is the trainee class in the series. Incumbents initially work under close supervision and receive on-the-job training in performing eligibility determination and case monitoring activities. Incumbents are expected to advance to the California Children's Services Specialist II level after one year of service at the California Children's Services Specialist I level.

California Children's Services Specialist II is the journey level in the series. Incumbents independently perform the most complex eligibility determination and ongoing case monitoring activities.

Receives and reviews applications for financial eligibility for medical care and treatment provided by County participation in the California Children's Services Program; interviews parents of children to obtain and evaluate information necessary to establish financial and residential eligibility; determines medical eligibility for specific medical services; authorizes payments for those medical services that do not require consultation with a health professional; explains the scope and limitations of the program, procedures and authorization processes; obtains data on income, share of cost and repayment obligation; discusses repayment schedules and plans with parents; prepares certification that family meets necessary requirements; manages financially and socially complex cases; consults with the program manager regarding appeals and problem cases; locates and researches other medical assistance programs for which clients may qualify; screens for eligibility to and explains the requirements and application processes of other medical assistance programs, such as MediCal and SSI, and assists clients in applying to those programs; reviews ongoing cases for continued financial eligibility and parents' compliance with treatment and repayment schedules; interprets the rules and regulations of the program for applicants, physicians, hospitals, and other providers; assists families ineligible for services of the program to locate alternate care; interacts with and communicates program-related information to clients experiencing grief and emotional crises; refers families to community resources as appropriate; acts as program consultant to medical therapy conferences; coordinates orthodontia screening conferences, which includes acting as a program consultant for orthodontists and educating families regarding program eligibility; maintains case records; prepares reports and statistical data related to cases; inputs, accesses, analyzes and prints data using a computer terminal; orients clerical staff and others to the CCS program; and may assist in training other California Children's Services Specialists.

Working knowledge of:

• Basic arithmetic.

Some knowledge of:

• Interviewing techniques for obtaining factual information.
• Medical terminology.
• Methods of organizing work.
• Record-keeping practices and procedures.
• Human motivation and behavior.

Working knowledge of the above, plus:

• Client or patient casework.
• Principal sources of information necessary to establish eligibility for public health assistance.

Some knowledge of:

• Specialized community resources available to children.

• The following abilities apply to level I as trainee and level II as journey.
• Read, understand, explain and apply complex regulations and policies governing public and private medical assistance programs.
• Gather, record and evaluate information necessary to determine initial and continuing eligibility for assistance.
• Exercise initiative and resourcefulness in locating other medical assistance programs, in order to facilitate cost containment.
• Exercise independent judgment and recognize those situations that require consultation with the program manager.
• Understand the emotional and social problems of families with terminally ill or severely disabled children.
• Organize and process transactions to meet frequent deadlines.
• Maintain systematic and accurate records.
• Recognize problems requiring referral to medical and allied resources.
• Establish and maintain effective working relationships with others.
• Communicate effectively in written and oral form.
• Prepare reports and statistical data.
• Perform basic arithmetic calculations.
• Input, access and analyze data using a computer.

Any combination of training and experience, which would provide the required knowledge and abilities, is qualifying. A typical way to obtain these knowledge and abilities would be:

One year of experience working in a medical or human services setting which has included client or patient contact. OR

Thirty semester units of successfully completed college level coursework in psychology, social work, sociology or a closely related field.

One year of experience in a medical or human services setting which has included interviewing, casework and application of rules and regulations.

License Requirement: Possession of a valid California class C driver license, or the ability to provide suitable transportation which is approved by the appointing authority.

Bargaining Unit: General Representation

EEOC Job Category: 03

Occupational Grouping: 64

Worker's Comp Code: 0290