Position Profile


Job Title:  AISH Generalist

Work Unit:  Access and Service Delivery / AISH Calgary

Ministry:   Alberta Children's Services / Community and Social Services

Competition Number:  1042062

Date:  April 2017
 

Position Summary

 

As part of a team of professionals, the AISH Generalist is responsible for assisting applicants and reviewing applicant assessment reports to determine whether the applicant is eligible for the Assured income for the Severely Handicapped (AISH) program. The position is responsible for determining applicant eligibility based on age, residence, income and assets and for assessing and categorizing applications according to their complexity. The incumbent reviews AISH assessment reports for eligibility in the following categories:

  • Applicant meets AISH eligibility criteria (PDD, Palliative, and Straightforward medical) -AISH Generalist determines eligibility.
  • Applicant does not appear to meet AISH eligibility criteria-AISH Generalist refers application to an AISH Adjudicator for adjudication.
  • Application is determined by the incumbent to be complex-AISH Generalist refers the application to an AISH Adjudicator for adjudication.

The position assesses alternative medical assessment reports submitted by the applicant and has the authority to accept these in lieu of a standard AISH Medical Report, if the incumbent determines that the alternative information is sufficient to determine AISH eligibility.

For complex cases, the AISH Generalist may be required to participate in a joint case review process with the AISH Adjudicator, AISH medical consultant or contracted service providers when appropriate.

The incumbent is responsible for assessing and managing situations where an AISH applicant’s financial resources exceed AISH income eligibility requirements but are insufficient to meet their basic living needs when an applicant or client and their cohabiting partner are separated due to one partner living in the community and one partner living in a facility. This includes gather relevant information to prepare and submit an application for Hardship Exemption to the AISH Adjudicator in order to allow AISH benefits to be granted to the applicant.

For approved applications, the incumbent calculates benefit entitlements and issues the AISH Living Allowance, Modified AISH Allowance and Personal Benefits to eligible clients. The incumbent also reviews ongoing client eligibility (i.e. income, assets and degree of impairment) of AISH clients.

The AISH Generalist is the primary contact for AISH clients or persons acting on their behalf.

The AISH Generalist facilitates the AISH application process by providing advice and support to applicants having difficulty completing their AISH application due to mental illness, cognitive impairment or physical incapacity. This may include individuals with significant communication challenges who require alternative communication methods and may involve identification and coordination of resources to assist the applicant to complete AISH application requirements. The AISH Generalist is also responsible for assisting approved AISH clients to meet their basic living needs and to achieve a level of independence. This may involve needs assessment and research into available community resources to meet those needs. If community resources are not available, the AISH Generalist is responsible for determining whether Personal Benefits may be an option to address need.

The AISH Generalist is also responsible for advising applicants who are denied AISH of their right to appeal, explains the appeal process, prepares detailed documentation for the consideration of the Citizens’ Appeal Panel and may be required to make oral presentations to the Panel at AISH appeal hearings.

The AISH Generalist must be knowledgeable of a wide variety of medical conditions and their potential effects upon clients’ daily functioning and have the ability to communicate effectively and sensitively with individuals with complex needs. The primary client group consists of persons with severe physical, mental or developmental disabilities. This includes individuals with significant social barriers with a lack of personal supports, and persons with significant communication barriers who may require alternative communication methods. Secondary client groups consist of family members, including persons acting as the client’s Court-appointed Guardian or Trustee or persons appointed by AISH to act as the client’s Financial Adjudicator. Other secondary client groups may include staff from other government programs (e.g. Alberta Works, PDD, etc.), community resource representatives, client advocates, physicians, psychologists, lawyers, financial planners and other persons who may be working with clients. Therefore the AISH Generalist is required to complete home visits; hospital visits; attend appeal hearings or court hearings; investigations meetings; and other travel job related activities as necessary.

Primary Accountabilities / Responsibilities

 

The AISH Generalist is the key contact for the AISH applicant or client and has primary responsibility for processing AISH applications as well as ongoing case management of approved files. AISH Generalists report to a supervisor. Responsibilities are identically described; however, work assignments may vary somewhat at different times, in response to changing operational requirements, level of staff skill and experience, case complexity and work volume.

The AISH Generalist is responsible for determining program eligibility, including medical eligibility for straightforward AISH applications, determining eligibility for medical equipment and supplies and other personal benefits, and is responsible for appropriate management of AISH appeals. Appeals involve the preparation of documentation for consideration by the AISH Citizens’ Appeal Panel as well as oral presentations at the appeal hearing on behalf of the Ministry, if required. (The Citizens’ Appeal Panel is a quasi-judicial body with the legislated mandate to review decisions of Ministry staff, including AISH eligibility decisions. The Panel can confirm, reverse or vary the decision of the Ministry.)

     
  1.

Intake Responsibilities

  • Responds to inquiries regarding the AISH program from prospective applicants, other involved parties and members of the public. Screens prospective applicants on the basis of age, residence, income and assets and proceeds with the AISH application for persons meeting the eligibility criteria.
  • Completes a preliminary needs assessment and assist the applicant to access available resources to meet those needs (e.g. Alberta Works program for interim financial assistance, mental health services, subsidized housing, support services for persons escaping an abusive relationship).
    Assesses and categorizes AISH applications according to their complexity and approves AISH applications where the applicant appears to meet AISH eligibility criteria. Determines which cases require referral to an AISH Adjudicator for adjudication because of case complexity or because the applicant, in the opinion of the worker, does not appear to meet AISH eligibility criteria.
  • Assesses and manages situations where the AISH applicant’s financial resources exceed AISH income eligibility requirements but are insufficient to meet their basic living needs when an applicant or client and their cohabiting partner are separated due to one partner living in the community and one partner living in a facility. This includes gathering and coordinating relevant information to prepare and submit an application for Hardship Exemption to the AISH Adjudicator in order to allow AISH benefits to be granted to the applicant.
  • Reviews and interprets financial information submitted by applicants, including information related to farms, businesses or investment portfolios. May refer complex files for further review by financial specialists if required.
  • Gathers appropriate documentation Prepares requests for Director’s Decision to temporarily exempt assets when a change in circumstance has resulted in a client exceeding the asset limit.
  • Gathers appropriate documentation and prepares requests for Director’s Decision to exempt assets in cases of financial hardship when requesting personal benefits.
  • Ensures that required application documents are received and follows up on missing documentation. Determines what information is required to make a decision on AISH eligibility.
  • Meets with applicants to review application documents. Has authority to accept appropriate alternative medical or assessment information (e.g. psychological assessments, medical reports used to establish eligibility for other programs, such as CPP-D) in lieu of the AISH Medical Report form. Explains AISH application process and provides support to applicants who are having difficulty completing their AISH application due to mental illness, cognitive impairment or physical incapacity. Completes a written assessment report of the applicant’s medical condition and how it affects activities of daily living and capacity for employment.
  • For approved applicants, calculates and issues the AISH Living Allowance, AISH Modified Allowance or Personal Benefits as appropriate.
  • Approves appointment of a Financial Administrator to assist applicants who are incapable of managing their AISH funds, after reviewing the Financial Administrator’s suitability. Explains Financial Administrator responsibilities and record keeping requirements.
  • Informs ineligible AISH applicants of their right to appeal, explains the appeal process and may assist the applicant to locate community resources to assist with their appeal. Prepares documentation for the consideration of the Citizens’ Appeal Panel and may make oral presentations at appeal hearings on behalf of the Ministry.
  • Informs ineligible applicants of alternative resources to meet their needs and assists applicants to access these services as required (e.g. Alberta Supports, Alberta Works Income Support, mental health services, student funding sources, etc.).
  • Coordinates applications for CPP-D through the AISH/CPP-D Coordinated intake process.
     
  2.

Support Services Case Management

  • Regularly completes file reviews of assigned AISH files. The audit of the AISH file involves a review of the client’s financial circumstances, medical status, current situation and continuous or non-continuous needs. Prepares a Case Management Plan, makes necessary revisions in response to changing circumstances and needs and determines next steps for managing the case.
  • Assists recipients to identify ongoing needs and supports, options for meeting those needs and reviews progress. Contact is through telephone discussions, written correspondence or in-person meetings.
  • Conducts periodic meetings with recipients are scheduled to discuss a wide range of topics including financial, personal and medical issues and where appropriate, employment and training issues. The intent of these meetings is to determine if a recipient requires further services and to assist with ongoing life management. These meetings may include discussion about the need for Personal Benefits and may include referrals to other resources for more complex cases.
  • Typical situations requiring action by the AISH Generalist include clients who are incapable of independently managing their AISH funds and who may require a Financial Administrator or Trustee, clients having difficulty locating and maintaining suitable housing and clients expressing interest in pursuing employment or training.
  • Provides immediate support to recipients who are in crisis may arrive unexpectedly at the AISH office and may require immediate support to address issues such as lack of food, medication or medical supplies suicidal thoughts, domestic violence, eviction and termination of utility service. AISH recipients may have ongoing aggressive and potentially violent behaviour, due to mental health or addictions issues and the AISH Generalist must use skill when responding, to avoid potential escalation and to ensure personal safety.
  • Determines eligibility for and authorizes immediate/emergency benefits such as payment of utility arrears to restore service or other emergency assistance available (e.g. assistance to escape an abusive relationship) through Personal Benefits. Personal Benefit requests also include requests medical supplies and equipment, assistance with moving, and or travel expenses.
  • Gathers appropriate documentation and prepares requests for submission to the Senior Manager for Director’s Decision for additional personal benefits where unique needs and circumstances exist and a client or their dependent child require goods and services that are not normally provided by the AISH program or exceed the maximum rate the worker has the authority to approve.
  • Gathers appropriate documentation and prepares requests for submission to the Heath Benefit Exception Committee when a client is requesting Health Benefits not normally covered by the Health Benefits Card.
  • Assesses client capacity to independently manage AISH funds and may appoint a Financial Administrator to assist. Monitors Financial Administrator’s records to ensure that recipient’s interests are protected. Recommends removal and prepares requests for Revocation of Financial Administrator in cases where there the Financial Administrator appears to have failed to act in the best interests of the client or when the Financial Administrator has failed to fulfill his or her responsibilities and duties.
  • Makes referrals to a variety of programs offered by different levels of government (public housing, subsidized or special needs transportation programs, Alberta Mental Health, Public Guardian or Public Trustee, AADAC, PDD, Alberta Supports, etc.) or community agencies (Canadian Mental Health Assoc., Distress Centre, Suicide Crisis Line, Food Bank, numerous disability and community organizations and support groups e.g. Multiple Sclerosis Society) to support clients in their life management and management of their medical condition. With client’s consent, may discuss client needs with community resource representative or other involved parties. Clarifies AISH program policies and procedures for community resource contacts.
  • Makes referrals to other programs to support clients in the management of their medical condition such as AADL, AAHB, and other AHS funded programs.
  • Makes referrals to OPGT as required.
  • Makes referrals of complex cases to senior AISH Delivery staff, Program and Policy resources, Financial Services resources for further assessment and support, if required.
  • Reviews and follows up on Case Management Plan, to assess client progress, determines next steps and if appropriate, modifies the Plan taking into account changing circumstances.
  • Encourages client to follow through on physician-recommended treatment and may initiate a review of recipient’s medical status and ongoing eligibility for AISH.
  • Documents case management activities on electronic or hardcopy client files as required.
     
  3.

Financial Case Management

  • Determines ongoing eligibility for the AISH Living Allowance or AISH Modified Allowance and assesses eligibility for Personal Benefits. Updates budget and issues benefits. Verifies financial circumstances including both income (currently over 60 different factors that may have impact on income calculation) and exempt or deemed assets as required.
  • Completes AISH annual reviews. The annual review is a thorough financial review of income and assets, including Income Tax Returns and Canada Revenue Agency (CRA) Notices of Assessment, Investments income/dividends, Income Funds (LIF, LRIF, RRIF, etc.)Passive business income etc. The generalist is often required to support clients to gather the required documentation for the review.
  • Reviews records kept by Financial Administrators appointed under the AISH Act, to ensure that AISH funds are appropriately managed on behalf of affected clients.
  • Coordinates and maintains third party payments to vendors as needed.
  • Responds to changes to a client’s financial circumstances and determines if further financial assistance is required. May provide Personal Benefits to eligible clients.
  • Prepares documentation required for consideration of client requests for Director Decision under AISH personal benefits program and ensures that supporting medical or other documentation is included with the request.
  • In conjunction with the supervisor, may initiate a fraud investigation referral in cases where fraud is suspected. Completes referral documentation, detailing circumstances of the case and coordinates any related documents submitted by the client. May be required to give sworn evidence in Court in cases where prosecution is pursued.
  • Calculates benefit overpayments and enters calculation into Recoveries System. Negotiates rate of recovery with client.
  • For overpayments that are for 12 or more periods of assistance and/or over $15,000, prepares Overpayment Review Checklists and submits to supervisor to for submission to Delivery Supports for review.
  • In conjunction with supervisor, prepares requests for Executive Director Decision for No Repayment of Overpayment.
  • Advises clients of their right to appeal, explains the appeal process and provides appeal documentation to clients when requested. Prepares documentation for presentation at an appeal hearing and may make oral presentations to the Citizens’ Appeal Panel on behalf of the Ministry.

Knowledge / Experience / Competencies

 

Knowledge:

  • Assured Income for the Severely Handicapped Act, Regulations, policy and procedures as well as local/regional procedures adopted to address operational requirements.
  • Working knowledge of Alberta Works, Alberta Adult Health Benefit (AAHB), Alberta Aids to Daily Living (AADL), and Office of the Public Guardian, Public Trustee, and Persons with Developmental disabilities (PDD) programs.
  • Working knowledge of other Ministry programs (e.g. Alberta Seniors Benefits, Housing), programs of other government ministries and levels of government (Canada Pension, Employment Insurance, Workers Compensation, special needs or subsidized transportation programs provided by municipalities, etc.)
  • Knowledge of a wide variety of external community resources, agencies and contracted services that provide services to persons with disabilities.
  • Knowledge of a wide variety of medical conditions and their effects upon functioning as well as treatment and rehabilitation approaches that may lessen the impairment caused by these conditions. Working knowledge of medical terminology.
  • Knowledge of social problems and barriers to successful community living.
  • Knowledge of case management techniques.
  • Knowledge of assessment, negotiation and problem-solving techniques.
  • Knowledge of information systems and how to utilize them.
  • Knowledge of computer software applications
  • Knowledge of occupational health and safety requirements, including Working Alone legislation.
  • Working knowledge of various investment vehicles, including mutual funds, RRSPs, annuities, etc.

Experience:

  • University degree in Social Work or Social Sciences plus one year of related experience, or diploma in Social Work or Social Sciences and two years of related experience.
  • Experience working with individuals with disabilities
  • Experience with determining eligibility for financial assistance programs
  • Case management experience and/or experience arranging supports for vulnerable individuals in a fast paced, high volume environment.

Competencies:

Drive for Results

  • Effective communication skills and the ability to conduct interviews for the purpose of assessing client circumstances and needs.
  • Demonstrated ability to work independently and to make case management decisions that reflect sound judgement, sensitivity and good stewardship of resources.

Creative Problem Solving

  • Capacity to work with persons with significant communication challenges (e.g. persons with developmental disabilities or mental health problems), including persons requiring alternative communication methods (e.g. deaf and hard of hearing).
  • Skilled in working with individuals who have ongoing aggressive and potentially violent behaviour, due to mental health or addictions issues.
  • Ability to negotiate effectively with individuals to find solutions to problems.
  • Ability to demonstrate strong needs assessment and problem-solving skills
  • Skilled in the interpretation of complex medical and assessment documentation.
  • Ability to interpret complex financial documents, including bank statements, investment statements, etc.
  • Proficient in conflict resolution and the ability to work effectively with persons who may become angry, frustrated or depressed due to their circumstances.

Systems Thinking

  • Strong report-writing skills and the ability to prepare clear and concise case summaries for presentation at appeal hearings.
  • Strong presentation skills required in order to represent the Ministry at appeal hearings, and present to stakeholder groups.

Build Collaborative Environments

  • Competent in building relationships with individuals, including representatives of community support agencies in order to assess and respond to individual needs.

Agility

  • Skilled in negotiating with clients (e.g. terms of Case Management Plan, rate of recovery in cases involving overpayment of financial benefits)
  • Strong organizational and time-management skills and the ability to balance routine tasks with complex, competing and urgent demands.

Develop Self and Others

  • Ability to motivate and provide encouragement to recipients to achieve their goals.

Build Collaborative Environments

  • Capacity to work effectively within a fast-paced team environment and to contribute to the achievement of Ministry goals.
  • Willingness to actively participate in team meetings, project committees and workgroups.

Develop Networks

  • Skilled in coordinating a variety of resources, both internal and external; to address problems that may threaten the client’s ability to live in the community or in some cases may be life-threatening.

Primary Responsibilities / Contacts

Clients Frequency Nature and Purpose of Contact
Internal

Other Ministry Staff

Daily

Liaise RE: complex client needs

Citizen’s appeal panel

Daily

Discussion of matters under appeal

External

AISH Applicants/Family Members, Court appointed Trustees/Guardians, Financial Administrators

Daily

Provide AISH program information, assess financial eligibility, process AISH applications, complete intake assessment, reports, assess client needs and eligibility for personal benefits, and discuss other options for meeting identified needs.

Client advocates, Physicians, Psychologists, Lawyers, Financial Planners, and Representatives of other government programs (municipal/federal), Community resources.

Weekly

Provide AISH program information and/or achieve a more thorough understanding of client needs and to determine resources available to meet those needs.

MLA office, Ombudsman’s office, Human Rights Commission

Weekly

Case specific contact for clarification of client circumstances


 

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