Service Compliance Officer

1. Maintain working knowledge of Arizona Long Term Care regulations as they pertain to Home and Community Based Services. Staying up to speed on any changes to Arizona Case Management Handbook and AHCCCS Medical Policy Manual (AMPM)

2. Responsible for the oversight of the client onboarding workflow in addition to screening of potential clients and their Caregivers for the determination of appropriate services, included applying proper regulations and guidelines related to eligibility, prioritization, and authorization.

3. Responsible for the development of the Client Service Plan and collaboratively work with the MCO Case Manager on any additional documentation that should be included in the Service Plan.

• Developing, recording, and maintaining a service plan.
• The service plan is an agreement between the Client or a Caregiver and the Case Manager, which identifies the service to be delivered as well as the frequency, duration, and goals of these services. 
• Assisting the Client or Caregiver or Personal Representative to reduce or eliminate barriers to the service plan. This role includes, resolving issues, which impede the Clients or Caregivers progress and access to services.

4. Responsible for assigning, introducing, and maintaining open lines of communication with Client and Assigned Caregiver.

• Responsible for the dismissal when warranted of the Client Caregiver Responsible for the replacement of the Client Caregiver for no call no show, behavior issues, and or not a good fit for the Client needs.
• Responsible for ensuring the assigned Caregiver and or Family Attendant has the appropriate credentials on file and meets the AHCCCS regulatory requirements for Direct Care Workers.
• Responsible for working closely with the organizations Direct Care Worker recruiter on identifying gaps in service areas and or need to increase Caregiver availability.
• Responsible for processing weekly DCW settlement

5. Provide ongoing monitoring of the clients and/or Caregiver’s status to determine the adequacy of services, to identify any changes in the clients or Caregiver’s condition, and to assist with ongoing needs.

6. Responsible for proper documentation and follow-up after referral of the Client services (e.g. ALTCS/Private Duty).

• Care Delivery Manager will be responsible for the weekly audit of all Service Compliance Officer charting and client census review.

7. Advocate on the Clients behalf with all involved agencies, MCO, organizations, and individuals.

8. Reassesses the Clients and/or Caregiver’s service need every 30, 60, 90, and 120 days or as needed.

9. In collaboration with the Client Case Manager determine when termination of services is appropriate, and the case should be closed.

10.Responsible for the documentation and communication to the Case Manager of any incidents that occurred during the Caregiver shift.

• Must follow incident reporting policy and procedure as dictated by the agency.
• Service Compliance Officer will be responsible for the creation, review, and approval process with Director of Operations for all incident and or reported grievance.

11. Responsible for identifying, planning, authorizing, arranging, negotiating, coordinating, monitoring, and managing costs of the service plan.

12. Responsible for ensuring that Clients and Caregiver or informal support system receives appropriate services and that the services received are of high quality.

13. Responsible for being cross trained in all components of the agency to ensure ample coverage

14. Willingness to provide services to clients as needed.