MEDICAL SOCIAL CARE SPECIALIST I, MEDICAL ASSISTANCE & HEALTH SERVICES

Definition

Under direction of a supervisory officer in a state department, is responsible for evaluating social care programs in accord with federal/state standards in Medicaid certified long term care facilities, institutions for the developmentally disabled, psychiatric hospitals, residential treatment centers, medical/social day care centers, home health agencies, and other social service provider agencies; does other related duties as required.

Examples of work

• Evaluates delivery of social services in health care facilities, medical day care programs, and social care programs, and facilitates their operation using social work skills, group work, and analysis and evaluation of data.
• Monitors development of required services, additional resources, and training programs, and provides technical problem-solving advice to certified facilities.
• Conducts the social service evaluation in the Periodic Medical Review and/or the Independent Professional Review of Medicaid approved health care facilities as mandated by the federal government.
• Analyzes social care activities in Medicaid health facilities including but not limited to social services, patient activities, patient rights, psychosocial services, residential services, therapeutic recreation, services to families, and interventions which impact on patient health.
• Evaluates quality of health facility social service staff, programs, therapies, and documentation, conducts interviews with residents, families, and facility staff, and reviews medical charts and patient accounts.
• Determines quality of the interdisciplinary team process and makes recommendation for improvement.
• Provides professional training and consultation to health facility social service staff.
• Interprets and integrates state/federal policies and standards on social service, makes recommendations for needed changes, and serves as a source regarding current federal/state social service regulations.
• Acts as patient advocate in situations requiring supportive intervention on the patient's behalf, and investigates and reports complaints and/or incidents of patient abuse as required by federal/state law.
• Performs social service quality assurance evaluations in cooperation with the Department of Health and Senior Services.
• Prepares materials to train facility staff in new therapies and problem-solving, keeping them abreast of changes in gerontology, mental health, developmental disabilities, and other related fields.
• Investigates complaints and deficiencies in the quality of care or safety of the health facility environment, reports violations, submits comprehensive, detailed reports and recommendations for corrections, and testifies in administrative hearings.
• Reviews financial records of health care facilities regarding use of patient Personal Need Allowance as federally mandated, and requests audits of financial records where indicated.
• Analyzes alternate care possibilities for institutional patients, based on available community resources, in cooperation with the Medical Evaluation Team, or in the case of institutions for developmentally disabled (ICF/MR) and psychiatric hospitals, with the facility staff.
• Establishes and maintains liaison with social service staff of other departments/divisions regarding mutual client needs.
• Participates in special projects and/or pilot programs to evaluate and strengthen efficiency and effectiveness of social care programs.
• Maintains records.
• Prepares monthly statistical and narrative reports.
• May serve as Acting Medicaid District Office Director in extraordinary circumstances.
• Reviews proposed federal/state legislation to identify impact on existing Medicaid social care programs, and develops and recommends alternative solutions to modify or assist in the development of legislation necessary to expedite implementation of new programs.
• Makes recommendations on Certificate of Need applications.
• Monitors social service staffing levels in Medicaid certified facilities in accord with Medicaid staffing standards.
• Will be required to learn to utilize various types of electronic and/or manual recording and information systems used by the agency, office, or related units.

Education

Graduation from an accredited college or university with a Bachelor's degree in Social Work or related field.

Experience

Three (3) years of experience in social work, two (2) years of which shall have been in the fields of gerontology, health care, or mental health/developmentally disabled or a combination thereof.

License

Appointees will be required to possess a driver's license valid in New Jersey only if the operation of a vehicle, rather than employee mobility, is necessary to perform essential duties of the position.

Knowledge, skills and abilities

• Knowledge of programs and responsibilities related to medical care programs.
• Knowledge of medical and social work terminology, common symptoms and diagnoses, and the social implications of disease and disability.
• Knowledge of the psychosocial aspects of medical care.
• Knowledge of community, medical, and other resources and/or services available for persons receiving public welfare services.
• Knowledge of legislation pertinent to public welfare and medical care.
• Ability to understand and utilize social work theory and objectives, especially as related to long term care and other health and social care programs for the elderly, mentally ill, and developmentally disabled.
• Ability to understand the social, psychological, economic, and physiological implications of aging.
• Ability to understand problems and practices of long term care facilities and other institutions, and their interdisciplinary composition and relationship to Medicaid programs.
• Ability to develop and supervise programs of social care service to long term care facilities and other institutions.
• Ability to read and understand information on the social, welfare, and health agencies and organizations in New Jersey, both public and voluntary.
• Ability to provide professional technical consultation to other professional staff.
• Ability to act in the capacity of an expert in the area of psychosocial care for patients in long term care facilities and other institutions.
• Ability to develop and provide training programs to professional social care staff.
• Ability to assist other professional staff in recognizing social problems and to improve staff awareness of social needs of recipients.
• Ability to comprehend and analyze laws, regulations, standards, and established procedures and the application thereof.
• Ability to function as a member of a team comprised of medical professionals.
• Ability to contribute and use research data for social planning.
• Ability to develop programs designed to afford an opportunity for continuous professional growth to other medical social work staff.
• Ability to review patient and other records to determine if standards of social service delivery are being met.
• Ability to prepare clear, sound, accurate, and informational statistical and other reports containing findings, conclusions, and recommendations.
• Ability to utilize various types of electronic and/or manual recording and information systems used by the agency, office, or related units. Ability to read, write, speak, understand, and communicate in English sufficiently to perform duties of this position. American Sign Language or Braille may also be considered as acceptable forms of communication.
• Persons with mental or physical disabilities are eligible as long as they can perform essential functions of the job after reasonable accommodation is made to their known limitations. If the accommodation cannot be made because it would cause the employer undue hardship, such persons may not be eligible.

Note

The examples of work for this title are for illustrative purposes only. A particular position using this title may not perform all duties listed in this job specification. Conversely, all duties performed on the job may not be listed.

A supervised and accredited field placement of three hundred (300) hours performed in a social service agency or a Master's degree in Psychology, Guidance and Counseling, Divinity, Social Work, or related behavioral science may be substituted for one (1) year of experience.