Job Title: Medicaid Waiver Case Manager
Department: Medicaid Waiver Program
Reports to: Clinical Coordinator(s) and/or Senior Team Lead
Schedule: Monday – Friday, with occasional nonstandard hours and overnight travel
Under the direction of the Medicaid Waiver Program Director this exempt employee coordinates and integrates all services required in a participant’s person- centered service plan, link participants to needed services, and ensure that participants continue to receive and benefit from services. Waiver case managers enable participants to receive a full range of services needed due to a medical condition, in a planned, coordinated, efficient, effective manner. Case management is a comprehensive service comprised of specific tasks and activities designed to coordinate and integrate all other services required in the participant’s service plan.
Essential Duties and Responsibilities:
- Development of service plans including coordination of formal and informal supports;
- Implementation of the Care Plan;
- Assessment and care planning for discharge from institutionalization;
- Annual and ongoing reassessments of Level of Care (LOC);
- Monthly face-to-face visits;
- Verification of Medicaid Eligibility;
- Extensive Documentation and record keeping
- Periodic updates of care plans;
- Monitoring the quality of home and community-based services;
- Determining and monitoring the cost effectiveness of providing home and community-based services;
- Information and assistance services
- Administrative guidance
- Outreach through a process of creating awareness in the professional community and in the general public of the availability of services in order to identify and establish contact with those who are appropriate for waiver services;
- Referral through identifying which persons in the community are in need of waiver services and making referrals to the appropriate program(s);
- Assess, follow-up, document, and report Critical Incidents complaint and grievances
- Participation in Medicaid Fair Hearings;
- Perform any other job duties as assigned by the Program Director and/or ADSS and Medicaid.
Record Keeping and Reporting
- Documents client assessment reviews;
- Documents quantity of work performed by established categories;
- Records activities and time spent using appropriate codes and forms; ensures time is correctly credited to specific clients and categories;
- Prepares reports of work activity, findings and other reports as needed.
- Develops and maintains general knowledge of the Medicaid Waiver program and of any other programs for which job duties are performed;
- Participate in various education and or training activities as required;
- Conducts seminars and education programs to publicize and educate the community about agency programs;
- Performs other duties as assigned.
- Bachelor of Arts or a Bachelor of Science degree, preferably in a human services related field, from an accredited college or university; or a registered nurse with a current license in Alabama;
- Must attend New Case Management (NCM) Training and complete the CORE Training modules within 30 days of attending the NCM Training;
- Must annually obtain at least 12 hours of training regarding Case Management services approved by ADSS under the HCBS Waiver;
- The case manager must have references which will be verified and documented in the personnel file. References must include statewide criminal background checks, previous employers, National Sex Offender Registry, and the Nurse Aide Registry if applicable. All case managers must meet required training requirements per ADSS and AMA guidelines.
Special Skill Requirements (*Can be acquired on the job):
- Basic knowledge of medical terminology.
- Knowledge of basic health needs and common cognitive issues of the elderly population.
- Basic knowledge of common medical conditions affecting the elderly population.
- Ability to write effective and clear correspondence, maintain records, and document procedures and interviews thoroughly and clearly.
- Ability to follow oral and written instructions.
- Ability to exercise judgment in evaluating difficult situations.
- Ability to organize work schedule and work independently.
- Ability to use Microsoft Office products for correspondence, reporting and analysis.*
- Ability to interpret and analyze healthcare data.
- Ability to use, review and document in case management software.*
The work environment involves everyday risks or discomforts which require normal safety precautions typical of such places as offices, meeting and training rooms, libraries, and residences or commercial vehicles, e.g., use of safe work practices with office equipment, avoidance of trips and falls, observance of fire regulations and traffic signals, etc. The work area is adequately lighted, heated, cooled and ventilated.
The work is sedentary. Typically, the employee may sit comfortably to do the work. However, there will be some walking; standing; bending; carrying of light items such as papers, books, small parts; driving an automobile, etc. No special or extreme physical demands are required to perform the work.
All resumes should be sent to firstname.lastname@example.org.