Waiver Case Manager

Overview

The Waiver Case Manager will work with clients located within the Gateway Region who participate in Medicaid’s Home and Community Based (HCB) Waiver Program. The Waiver Case Manager will conduct clinical and general case management and financial oversight of developed care plans while ensuring the needs of each client are met in a timely and professional manner. The Waiver Case Manager must maintain confidentiality of all clients.

Participant Directed Services (PDS) and Traditional Waiver Case Management: Involves developing and maintaining a Plan of Care for PDS and Traditional Waiver clients, completing required home visits and telephone calls, and data entry. This duty will consist of:

• Conduct face-to-face visits every month with PDS clients and every other month with Traditional Waiver clients;
• Contact Traditional Waiver clients during the months that face-to-face visits are not performed;
• Conduct telehealth visits every other month with PDS clients who have provided telehealth consent;
• Data entry and case notes in the Medicaid Waiver Management Application (MWMA);
• Develop, maintain, modify, and review a Plan of Care for each client;
• Ensure services are being provided in accordance with the client’s person-centered service plan;
• Work with Medicaid providers to ensure services are being provided in accordance with the Plan of Care;
• File maintenance and documentation;
• Assist the client in collecting new PDS employee paperwork, including withholding documentation, eligibility verification, and employees/client contract;
• Track PDS employee background checks, trainings, certifications, and other program requirements (i.e., Tuberculin (TB) skin tests, CPR/First Aid certification, attendant care training);
• Issue a corrective action plan when the Plan of Care is not being followed or when there is a threat to the health, safety, and welfare of the client;
• Terminate clients from the program when the program cannot sufficiently meet the client’s requirements, when imminent threats exist to the client, when a client or representative refuses to follow the corrective action plan, or when services are utilized within 60 days;
• Review PDS employee time entries for completeness, compliance with the Plan of Care, and Electronic Visit Verification (EVV) requirements;
• Evaluate the client’s expenditures and balance of services available at each monthly face-to-face visit; and
• Conduct eligibility checks at the beginning of each month to verify that each client is Medicaid eligible and remains active.

Involves collaborating with Gateway Area Development District’s Finance Department to correct issues with EVV and payroll for the Medicaid Waiver Program. This duty will consist of:

• Address participant’s comments/complaints/questions in a professional manner;
• Review PDS employee EVV system usage to ensure accuracy;
• Identify and make EVV corrections following correction submissions or visit notes;
• Troubleshoot EVV issues with checking in/checking out;
• Follow up with employee(s) on inconsistencies with EVV’s geofencing and submitted visits; and
• Help maintain clients and users in the EVV system to prevent inactive users.

Involves any other tasks and assistance needed to support the Aging & Independent Living Department.

Education:

• Bachelor’s degree or higher in a social work or human services field from an accredited college or university; or a bachelor’s degree in any field not closely related and one year human services related experience; or an associate degree in a behavioral science, social science, or closely related field and two years human services related experience; or three years of human service related experience;
  
  or be a Registered Nurse currently licensed in Kentucky who has at least two (2) years of experience as a professional nurse in the field of aging or disabilities; or have a master’s degree in a health or human services field from an accredited college or university. Relevant fields of study may include social work, psychology, rehabilitation, nursing, counseling, education, gerontology, human services, and…