Medical/Social Services Consultant I (#MDDG01)
$43,900.00 Yearly Min / $54,875.00 Yearly Mid / $65,850.00 Yearly Max

Medical/Social Services Consultant II (#MDDG02)
$49,708.00 Yearly Min / $62,135.00 Yearly Mid / $74,562.00 Yearly Max

This class series describes complex medical case management, advocacy, and consultation in a healthcare setting, often as a member of a multidisciplinary treatment team or as a liaison with managed care organizations or other insurance entities.  Employees manage and facilitate services for clients diagnosed with complex, chronic, and specialized physiological medical conditions while applying comprehensive knowledge in State/Federal insurance programs and regulations. 

The Medical/Social Services Consultant class series is distinguished from the lower-level case management classes through a broader scope of responsibility for advocacy, education, and consultation across public, private, and community sectors, with an emphasis on insurance/program entitlements and complex medical care and service integration.

Essential functions are fundamental, core functions common to all positions in the class series. These functions are not an exhaustive list of all job duties for any one position in the class. Since class specifications are descriptive and not restrictive, employees can complete job duties of a similar kind not specifically listed here.

• Manages cases over the continuum of a healthcare delivery system for clients with complex, chronic, and specialized physiological medical conditions.  Facilitates access to medical and social service resources across public, private, and community sectors. 
• Collaborates with health care providers, services, programs, and insurance entities to develop tailored service plans and interventions.  Integrates care and communication between stakeholders to ensure optimal health and social outcomes. 
• Navigates and consults on the intersection of services, authorizations, and payments between the clients, providers, insurance programs and/or Managed Care Organizations.  Works with providers and insurance entities to obtain pre-authorizations and referrals. 
• Schedules and attends multidisciplinary evaluations and assessments.  Facilitates and participates in discharge and transition planning.
• Formally responds to casework inquiries and investigates complaints, assessing services or eligibility against legal entitlements or contracts.  
• Provides subject matter expertise through outreach and education to program staff, community members, providers, and other stakeholders through special community events or health education and preventative services.  Advocates for community health and wellness. 
• Maintains and tracks service, eligibility, and referral data sets, manages data for reporting and program planning. Coordinates and allocates funding sources for special program eligibility.        
• May support emergency preparedness and response efforts during pandemics or natural disasters, and/or intervene in facilitating care for clients in health crisis.  May provide home visits, and/or virtual appointments.
• Performs other related duties as required.

The intent of the listed knowledge, skills, and abilities is to give a general indication of the core requirements for all positions in the class series; therefore, the KSA’s listed are not exhaustive or necessarily inclusive of the requirements of every position in the class.

• Knowledge of the principals, practices, and techniques of complex medical care coordination and case management practices.
• Knowledge of the social factors affecting the disease process or health concerns.
• Knowledge of community agencies and resources for educational, health, and social services.
• Knowledge of medical terminology and medical diagnostic categories.
• Skill in interviewing to obtain client case histories.
• Skill in individual and family coaching, direction, and guidance methods and techniques.
• Ability to coordinate case management for multidisciplinary treatment teams in regards to the social aspects of a client's complex medical or health problem.
• Ability to provide training and guidance in the resolution of medical/social services case management problems.

In addition to the above knowledge, skills, and abilities, the Medical/Services Consultant II requires:

• Knowledge of methods and techniques used to evaluate Social Determinants of Health and eliminate adverse factors impacting the health care management process of clients.
• Knowledge of methods and techniques used in preparing statistical reports related to identification and analysis of patterns/trends.
• Skill in providing consultative services.
• Skill in advance case management practices and principals.
• Skill in quality improvement methods such as evaluating the quality of services, identifying problems and needs and recommending corrective action and improvements to ensure optimum service delivery.
• Ability to coordinate and lead public facing outreach events.
• Ability to interpret and measure compliance with applicable laws, rules, regulations, and standards.
• Ability to effectively lead and motivate others.

JOB REQUIREMENTS for Medical/Social Services Consultant I
Applicants must have education, training and/or experience demonstrating competence in each of the following areas:

1. Possession of a Bachelors degree or higher in Health, Behavioral or Social Science or related field.
2. One year of experience in case management such as assessing, planning, developing, implementing, monitoring, and evaluating options and services to meet an individual's human service needs.
3. One year of experience in making recommendations as part of a client's service plan such as clinical treatment, counseling, or determining eligibility for health or human services/benefits.
4. One year of experience in client healthcare resource coordination and support.
5. Six months experience in interpreting laws, rules, regulations, standards, policies, and procedures.
6. Six months experience in narrative report writing.