CHARLES HUGHES

🔍 Eligibility Review & Redetermination 📑 Case Management & Documentation 📞 Client & Provider Communication ⚖️ Policy Compliance & Decision-Making 🧠 Continuous Learning & Updates

• Review client cases on a regular schedule (often annually) to determine continued eligibility for long-term care services.
• Assess financial information , such as income, assets, and expenses, to ensure compliance with Medicaid or other program limits.
• Evaluate medical necessity documentation to confirm the need for ongoing care.
• Collect and verify documents from clients, family members, or representatives (e.g., bank statements, insurance policies, care plans).
• Maintain accurate, updated case files in the system, ensuring proper documentation of all actions taken.
• Enter data into state or agency systems and update records as needed.
• Contact clients or their representatives to request necessary documentation or clarify information.
• Work with long-term care providers (e.g., nursing homes, home health agencies) to verify services and coordinate on eligibility matters.
• Provide clear guidance to clients about program rules and what documentation is needed.
• Ensure all determinations comply with state and federal regulations (e.g., Medicaid rules).
• Make decisions on continued eligibility and issue appropriate notices of approval or denial .
• May participate in appeals or hearings if a decision is challenged.
• Stay updated on policy changes or program updates that affect long-term care eligibility.
• Attend training sessions or review policy manuals as needed.
• Trained new case managers, raising team's overall competency and service delivery standards.

• Conduct initial interviews with clients and/or families to gather personal, medical, financial, and social history.
• Assess client eligibility for long-term care services based on established criteria.
• Explain available long-term care programs, benefits, and services to clients.

• Complete and maintain accurate records, forms, and reports related to client intake.
• Enter and update client data in electronic case management systems.
• Ensure all required documentation is received and properly filed.

• Refer clients to appropriate community resources or specialized services as needed (e.g., Medicaid, food assistance, housing).

• Advocate for clients' rights and needs within the intake process.
• Assist clients in understanding their care options and navigating complex systems.
• Act as a liaison between clients, families, and providers.

• Ensure compliance with local, state, and federal regulations regarding long-term care intake.
• Follow protocols for HIPAA and client confidentiality.
• Stay updated on changes in eligibility criteria or program guidelines.

• Provide updates and input on client progress or barriers to care.
• Collaborate on the development of care plans when appropriate.

• Answer phone calls and respond to inquiries from clients, families, and other agencies.
• Support the Central Intake Unit in streamlining processes and improving service delivery.

• Facilitated group therapy sessions for diverse clientele, promoting peer support and healthy coping mechanisms.
• Established strong rapport with clients from diverse backgrounds and demographics, fostering an atmosphere of trust for open communication during counseling sessions.
• Conducted substance abuse assessments and screenings to accurately identify client needs and appropriate levels of care required.
• Streamlined case management processes to reduce administrative burden and increase time spent providing direct client services.
• Expanded community outreach efforts, resulting in increased awareness of available substance abuse resources and prevention initiatives.
• Promoted a safe therapeutic environment that fostered trust between clients and counselors by setting clear boundaries and expectations.
• Collaborated with multidisciplinary teams to develop holistic treatment plans addressing the unique needs of each client.
• Mentored new counselors by sharing best practices, contributing to a positive team environment and continuous professional development opportunities.
• Evaluated program effectiveness using data-driven assessments, leading to ongoing improvements in service delivery outcomes.
• Developed targeted intervention strategies for at-risk individuals, resulting in increased engagement and participation in treatment programs.
• Ensured compliance with federal, state, and local regulations governing addiction counseling practices through meticulous record-keeping procedures.
• Assisted families in understanding addiction-related issues, fostering supportive environments during the recovery process.
• Connected clients with relevant social services agencies for housing assistance, employment support, or additional mental health services when needed.
• Navigated complex documentation requirements while maintaining strict confidentiality standards as mandated by state regulations and ethical guidelines.
• Displayed sensitivity to cultural and linguistic needs of clients and families served.
• Guided clients in effective therapeutic exercises integrated from Cognitive Behavior Therapy and Dialectical Behavior Therapy (DBT).
• Provided comprehensive case management services, created treatment plans, and connected clients and families to appropriate resources.
• Developed goal-oriented psychoeducational and activity therapy groups to improve clients' level of functioning.
• Used knowledge of different treatment modalities to provide clients with individualized options for successful outcomes.
• Provided counseling and support to clients with drug and alcohol abuse issues.
• Provided crisis intervention to address clients' immediate needs and prevent harmful behaviors.
• Facilitated group and individual therapy in outpatient setting.
• Kept accurate and detailed records to track and document client progress.
• Developed individual treatment goals based on history and diagnosis.
• Supported aftercare planning for continued recovery after treatment.
• Monitored client progress to make necessary adjustments for client success.
• Supported and assessed clients struggling with addiction or relationship issues and devised strategies based on client needs.
• Continuously updated professional knowledge by attending conferences, completing continuing education courses, and participating in industry-related workshops to enhance service delivery outcomes.