• Responsible for monitoring and measuring the operational flow of the department • Task responsibilities to staff including intake, processing, and review of medical records • Ensure medical necessity as well as ensuring the inbound calls have handled in a matter that reflects ideal metrics • Provide great experience for customers and the PAP team • Prioritize and develop departmental objectives • Conduct effective resource planning to maximize productivity of resources • Analyze statistics relative to metrics set for the department • Ensure staff are appropriately trained and held accountable for achieving standards and goals • Identify root cause of issues and work with others to improve overall processes • Evaluate performance with key metrics (accuracy, call-waiting time etc.) • Ensure consistent administration of staff compliance with all company and departmental procedures • Manage department budget and expenses • Prepare reports as needed for various departments and leadership as requested • Train new hires according to standards and provide ongoing training as changes occur • Develop and/or maintain Standard Operating Procedures (SOP’s) that support the work of the team.

• Provide complex care coordination and monitoring to members having a primary Intellectual or Developmental Disability, which may include secondary mental health or substance abuse, and/or complex medical/physical health needs. • Utilize person centered planning methods/strategies to gather information, to get to know the members supported and to adequately address specific needs of the individual. • Provide education and support to members in learning about and exercising rights and responsibilities. • Consistently complete Discovery activities (information gathering and assessment) as a component of the planning process. • Ensure that members/legally responsible people are informed of services available (all types of Medicaid and state-funded services), service options available (e.g. Individual/Family Direction for Innovations participants), processes (e.g. requirements for specific service), Natural and community services, and so forth. • Assist members/legally responsible people in choosing service providers, ensuring objectivity in the process.

• Assist the member supported to direct the planning process/plan development to the extent desired by the member. • Facilitate timely development of the Comprehensive Care Management Assessment, Individual Support Plan/Care Plan, Crisis Plan, 1915(i) Assessment, and other assessments as needed. • Collaborate with members supported and members of the support team to ensure development of a comprehensive plan that reflects the member’s needs and desired life goals, as well as the physical, behavioral health, and social determinant needs, service delivery, and health and safety of the member. • Responsible for ensuring Care Coordination engagement, collaboration with members, and families to address issues, concerns, barriers to assessment and services/supports. • Provide resources and information to members, parents, and caregivers, as needed.

• Act as a single point of contact between the internal team, client, provider, payor, facility, and patient as needed • Support cases through approval/denial process with a sense of urgency while maintaining accuracy • Provide direction to the aligned Payor Specialist Team and coordinate efforts to ensure accuracy and completeness of each case • Identify and share trends impacting business processes with management • Prioritize and act on key client activities and follow up with customers to ensure problems are solved • Manage through ambiguity while designing innovative client and payor solutions • Make sound independent decisions in urgent and non- routine situations pertaining to client and patient scenarios • Interpret complex clinical documentation to prepare authorization documentation for payor submission in relation to medical policy criteria for coverage • Partner with the interdisciplinary team to champion their clients, patients and customers and is responsible for the life cycle of their case to ensure successful completion • Provide resources to patients, caregivers, health care providers and clients with resources available for financial assistance and transportation • Provide compassionate and empathetic support to patients and care givers with life-threatening diagnoses • Coordinate with various service providers and healthcare professionals to ensure patients receive the appropriate support before and after surgery