medicaid case manager

CAPTAIN Youth and Family Services

Job Title: 1115 Waiver Case Manager (Full Time, Non-Exempt)Job Summary:The Case Manager will deliver services per the Momentum grant requirements for individuals who have Medicaid coverage under the 1115 Waiver. Services will include screening, navigation and linkages for health-related social needs. The Case Manager will coordinate transportation services for eligible clients with agency van and drivers. The Case Manager will complete all documentation, including eligibility, social care plans, and billing requirements ensuring the agency&rsquo;s compliance with Medicaid standards.Duties and Responsibilities:<ul><li>Complete Health Related Social Needs (HRSN) screenings to assess clients HRSNs.</li><li>Receive incoming referrals from both internal sources and Unite Us for screening and navigation to assess client HRSNs.</li><li>Eligibility assessment with clients to determine the level of enhanced HRSN services.</li><li>Assist clients that have qualifying HRSNs with coordinating them to the proper Social Care Navigator.</li><li>Provide follow-up support as needed.</li><li>Coordinate with eligible clients to set up transportation needs.</li><li>Manage transportation staff (managing the calendar, setting up transportation and communicating with the drivers).</li><li>Develop individual service or care plans.</li><li>Manage documentation of services in all required databases in a clear, accurate and timely manner.</li><li>Track outcomes, document progress, and ensure data collection complies with Medicaid reporting standards.</li><li>Ensuring the confidentiality of all case information, and the security of all digital communications.</li><li>Complete all reports in a timely manner.</li><li>Complete all required trainings per Agency and Healthy Alliance standards in a timely manner.</li><li>Complete and maintain a &ldquo;how to&rdquo; guide of daily responsibilities.</li><li>General front desk and office coverage, on an as needed basis</li><li>Complete and document required job-related training.</li><li>Perform other related work as assigned.</li></ul>Skills Required:<ul><li>Ability to work with all ages and income levels and be a dedicated client advocate.</li><li>Knowledge of community resources.</li><li>Able to multi-task and work in a team environment.</li><li>Solid working knowledge of Microsoft Office products</li></ul>Qualifications:<ul><li>Bachelor&rsquo;s (preferred) or Associate&rsquo;s degree from an accredited college or university in human services, counseling, education or related field.</li><li>Case management and Medicaid billable service provision preferred.</li><li>Must possess a valid NYS Driver&rsquo;s License with driving record acceptable to Agency insurance standards and provide evidence of appropriate vehicle insurance coverage.</li><li>Ability to lift at least 30 lbs.</li></ul>Telecommuting and Remote Work: The primary functions of this position require in-office and in-community services. Occasionally, project assignments could be accomplished remotely with supervisor permission.Employer Disclaimer:<ul><li>Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by their direct supervisor.</li><li>This job description does not create an employment contract, implied or other than an &ldquo;at will&rdquo; employment relationship.</li></ul>CAPTAIN CHS is proud to be an Equal Opportunity Employer (EOE).Job Type: Full-timePay: $23.08 per hourBenefits:<ul><li>401(k)</li><li>Dental insurance</li><li>Employee assistance program</li><li>Flexible spending account</li><li>Health insurance</li><li>Health savings account</li><li>Life insurance</li><li>Paid time off</li><li>Retirement plan</li><li>Vision insurance</li></ul>License/Certification:<ul><li>NY State Driver's License (Required)</li></ul>Work Location: In person

1115 Waiver Case Manager

GOLDEN YEARS ADULT DAY CARE

<div><h4 class="jobSectionHeader">Our Mission</h4>
Our mission is to treat every day, and every person, as a sacred opportunity to serve. Guided by the Golden Rule, we offer respectful, kind, and empathetic care that uplifts seniors, supports families, and strengthens our community.
<h4 class="jobSectionHeader">
Our Vision</h4>
Our vision is to be the heartbeat of the communities we serve through compassionate care, so every person feels seen, valued, and at home.
<h4 class="jobSectionHeader">
The Opportunity</h4>
Join our dynamic healthcare team as a Case Manager specializing in Medicaid and HCB Waiver Services. This is not just case management, it's life-changing advocacy that empowers vulnerable adults to live independently and thrive in their communities.
<h4 class="jobSectionHeader">
What makes this role unique:</h4><ul><li>
Hybrid flexibility Balance office coordination with meaningful home visits</li><li>
Sacred impact Turn care plans into real independence for Kentucky seniors.</li><li>
Local connection Serve your own southcentral Kentucky community.</li><li>
Expert development Structured training with waiverspecific guidance</li><li>
Missiondriven culture Work with a team that genuinely lives the Golden Rule</li></ul>
What You'll Do
<h4 class="jobSectionHeader">
Leading Person-Centered Care</h4><ul><li>
Coordinate personalized care plans that empower participants to remain safely at home.</li><li>
Complete comprehensive assessments and develop Individualized Service Plans (ISPs) per Kentucky Medicaid requirements (907 KAR 7:010)</li><li>
Conduct regular home and community visits to monitor health, safety, satisfaction, and goal progress.</li><li>
Advocate for participant preferences and rights, facilitating informed choices.</li><li>
Coordinate services across Golden Years programs and external providers (attendant care, transportation, therapies) within authorized scopes.</li></ul><h4 class="jobSectionHeader">
Ensure Regulatory Excellence</h4><ul><li>
Maintain compliance with Kentucky Medicaid/HCB Waiver regulations, including conflictfree case management requirements.</li><li>
Complete all assessments, ISPs, reviews, and progress notes within mandated timeframes.</li><li>
Document contacts, visits, coordination, and critical incidents for audit readiness.</li><li>
Review service utilization, identifying and correcting under or overutilization.</li><li>
Participate in quality improvement initiatives and corrective actions.</li></ul><h4 class="jobSectionHeader">
The Work Environment</h4>
Hybrid Model: Combination of office-based work (documentation, virtual meetings at Edmonton location) and field work (home/community visits throughout service area)

Schedule: Full-time, standard weekdays with flexibility for participant visits

Travel: Local travel within service area required; reliable transportation essential
<h4 class="jobSectionHeader">
Location Preference</h4>
We strongly prefer candidates residing in Metcalfe County or the six bordering counties:
<ul><li>
Metcalfe County (Edmonton base)</li><li>
Fayette County (Lexington)</li><li>
Jefferson County (Louisville)</li><li>
Counties surrounding Lexington and Louisville</li></ul>
Local knowledge and proximity strengthen relationships with participants and enable responsive, community-connected care.

What You Bring
<h4 class="jobSectionHeader">
Required Qualifications</h4><ul><li>
Bachelor's degree in social work, nursing, human services, or related field (preferred)</li><li>
Experience in case management, care coordination, or waiver services (required)</li><li>
Knowledge of personcentered planning and conflictfree case management</li><li>
Strong assessment, planning, and problemsolving skills balancing participant choice, safety, and regulations.</li><li>
Excellent written/verbal communication for documentation and stakeholder interactions</li><li>
Organized time management for caseloads, deadlines, and accurate records</li><li>
Valid driver's license and reliable transportation (Travel is required)</li><li>
Current auto insurance</li></ul><h4 class="jobSectionHeader">
Highly Valued</h4><ul><li>
Kentucky Medicaid/HCB Waiver experience</li><li>
Familiarity with 907 KAR 7:010 requirements</li><li>
Cultural competence working with diverse populations.</li><li>
Electronic health record system experience</li></ul><h4 class="jobSectionHeader">
Pre-Employment Requirements</h4><h4 class="jobSectionHeader">
All candidates must successfully complete:</h4><ul><li>
Criminal background check</li><li>
Drug screen</li><li>
TB test</li><li>
Driver's license and auto insurance verification</li></ul>
Timeline: Formal offers require acceptance and onboarding completion within 48 hours.
<h4 class="jobSectionHeader">
Cultural Expectations</h4><h4 class="jobSectionHeader">
We expect every team member to:</h4><ul><li>
Live out the Golden Rule with participants, families, and teammates daily</li><li>
Demonstrate respect, kindness, and empathy consistently.</li><li>
Support safe, choicedriven services that honor dignity and independence.</li><li>
Embody servant leadership, putting participants' goals at the center.</li></ul>
How to Apply
<h4 class="jobSectionHeader">
Submit:</h4>
1. Resume highlighting case management/waiver experience and relevant education.
2. Brief cover letter describing:<ul><li>
Your case management or waiver coordination experience o How you embody the Golden Rule in professional practice</li><li>
Why Golden Years ADHC's mission resonates with you?</li><li>
Your connection to Lexington and Louisville or surrounding area (if applicable)</li></ul><h4 class="jobSectionHeader">
Contact:</h4>
Call 270-432-2044 to speak with Team Care leadership (McKenzie or Sarah)

Golden Years Adult Day Healthcare (ADHC) 903 W Stockton Street, Edmonton, KY 42129

Job Type: Full-time Work Location: Hybrid (Office + Field) Service Area: Metcalfe County and surrounding North Central and Eastern Kentucky.</div>

Case Manager - Medicaid/HCB Waiver Services

Connections Case Management LLC

Start Date: 6-1-26Position: Medicaid Waiver Case ManagerService Area: Case Manager will be serving Hancock and surrounding counties. This position requires working remotely from your home office and travel within your service area. This is NOT a fully remote position. You must live within the service area to be considered for this position.Job Summary: Case Managers support individuals participating in a Medicaid waiver program. The CM will ensure they have access to services available on the waiver, other Medicaid state plan services as well as providing additional resources within their community. A primary role in this position is one of advocacy for the individuals we serve.Responsibilities and Duties:&middot;&middot; Following a person-centered process&middot; Annual Planning&middot; Quarterly Monitoring face to face&middot; Maintaining and managing all electronic records&middot; Facilitating interdisciplinary team and other meetings&middot; Completing/maintaining each individual's waiver budget&middot; Monitoring service delivery and utilization&middot; Ensuring individuals' health and welfare&middot; Maintaining/Building relationships with individuals, families, guardians, providersSkills: &middot;&middot; Ability to plan, organize, manage time, and work productively in a virtual environment under minimal supervision to provide timely and quality service delivery for individuals&middot; Intermediate level of technology skill; strong oral and written communication skills&middot; Team facilitation&middot; Critical thinking&middot; Attention to detail&middot; Team collaborationWork Schedule:&middot; Monday- Friday 8-4:30, 40-hour work week, with the expectation to return contact within 24 hours (with exception of weekends/holidays)&middot; Virtual and community-based work environment&middot; 24 hour crisis line and staff responsible for handling after hour emergencies&middot; Ability to flex schedule to facilitate face to face meetings with individuals who cannot meet during business hours&middot; Autonomy in scheduling home visitsKnowledge/Experience: Must have a Bachelor&rsquo;s degree in Psychology, Social Work, Counseling, Nursing, Special Education, Rehabilitation, Gerontology, or another field of study with one year of direct work experience with persons with intellectual disabilities.Required: Authorization to access State of Indiana&rsquo;s operating systems. CPR certification, annual TB Test, valid driver&rsquo;s license, current auto insurance, proof of education. Ability to pass a background check and arrest record. CM must have a dedicated home office space where Protected Health Information cannot be accessed by others. CM is required to have all furnishings for a home office- internet, phone, computer, and ability to print. Reliable transportation.Preferred: Knowledge or experience of case management; experience in team facilitation; and experience working from home. Experience with Health and Wellness Waiver, Traumatic Brain Injury Waiver, Family Support Waiver or Community Integration Habilitation WaiverBenefits:&middot; Medical, dental and vision&middot; 401K&middot; Life Insurance- company paid&middot; Supplemental plans available&middot; 15 days paid vacation, plus 11 paid holidays&middot; iPad and keyboard, with data services and personal hotspot&middot; A laptop computer is available throughout orientation, upon request&middot; Wifi extender, upon request/need&middot; Salary ranges are based on level of experience and ability to meet quality expectations for caseload&middot; Ongoing professional development in a supportive environment&middot; Promotional opportunities - Connections believes in the talents of our team and promotes within&middot; Caseload resides in home and surrounding counties, reducing mileageConnections Case Management understands that employees are more than just case managers. They have families and lives outside of their professional careers. Our company values the health and well-being of our employees. We understand that if we provide supports that allow our employees to have a quality life at work and home, a good income and personal time away from work responsibilities, the return will be in quality supports for those they have on their caseload.Every employee does Case Management at Connections. The average caseload is 45 individuals. Each case manager is part of a smaller, regionally based team of 4-7 people which allows for direct quality support and monitoring by a supervisor. Additionally, your role as case manager is supported with an open and accessible team concept. Because Connections serves all 92 counties in Indiana, employees are encouraged to use all forums to connect with colleagues and utilize a team approach to Case Management.For more information about Connections Case Management please visit us at www.connectionsin.com where you can also download an application. Please also look us up on social media and check out our reviews on Glassdoor!Job Type: Full-timePay: $42,000.00 - $57,000.00 per yearBenefits:<ul><li>401(k)</li><li>401(k) matching</li><li>Dental insurance</li><li>Employee assistance program</li><li>Flexible schedule</li><li>Flexible spending account</li><li>Health insurance</li><li>Health savings account</li><li>Life insurance</li><li>Paid time off</li><li>Parental leave</li><li>Retirement plan</li><li>Vision insurance</li></ul>Work Location: On the road

Case Manager- Medicaid Waiver

Start Date: 6-1-26Position: Medicaid Waiver Case ManagerService Area: Case Manager will be serving Lake and surrounding counties. This position requires working remotely from your home office and travel within your service area. This is NOT a fully remote position. You must live within the service area to be considered for this position.Job Summary: Case Managers support individuals participating in a Medicaid waiver program. The CM will ensure they have access to services available on the waiver, other Medicaid state plan services as well as providing additional resources within their community. A primary role in this position is one of advocacy for the individuals we serve.Responsibilities and Duties:&middot;&middot; Following a person-centered process&middot; Annual Planning&middot; Quarterly Monitoring face to face&middot; Maintaining and managing all electronic records&middot; Facilitating interdisciplinary team and other meetings&middot; Completing/maintaining each individual's waiver budget&middot; Monitoring service delivery and utilization&middot; Ensuring individuals' health and welfare&middot; Maintaining/Building relationships with individuals, families, guardians, providersSkills: &middot;&middot; Ability to plan, organize, manage time, and work productively in a virtual environment under minimal supervision to provide timely and quality service delivery for individuals&middot; Intermediate level of technology skill; strong oral and written communication skills&middot; Team facilitation&middot; Critical thinking&middot; Attention to detail&middot; Team collaborationWork Schedule:&middot; Monday- Friday 8-4:30, 40-hour work week, with the expectation to return contact within 24 hours (with exception of weekends/holidays)&middot; Virtual and community-based work environment&middot; 24 hour crisis line and staff responsible for handling after hour emergencies&middot; Ability to flex schedule to facilitate face to face meetings with individuals who cannot meet during business hours&middot; Autonomy in scheduling home visitsKnowledge/Experience: Must have a Bachelor&rsquo;s degree in Psychology, Social Work, Counseling, Nursing, Special Education, Rehabilitation, Gerontology, or another field of study with one year of direct work experience with persons with intellectual disabilities.Required: Authorization to access State of Indiana&rsquo;s operating systems. CPR certification, annual TB Test, valid driver&rsquo;s license, current auto insurance, proof of education. Ability to pass a background check and arrest record. CM must have a dedicated home office space where Protected Health Information cannot be accessed by others. CM is required to have all furnishings for a home office- internet, phone, computer, and ability to print. Reliable transportation.Preferred: Knowledge or experience of case management; experience in team facilitation; and experience working from home. Experience with Health and Wellness Waiver, Traumatic Brain Injury Waiver, Family Support Waiver or Community Integration Habilitation WaiverBenefits:&middot; Medical, dental and vision&middot; 401K&middot; Life Insurance- company paid&middot; Supplemental plans available&middot; 15 days paid vacation, plus 14 paid holidays&middot; iPad and keyboard, with data services and personal hotspot&middot; A laptop computer is available throughout orientation, upon request&middot; Wifi extender, upon request/need&middot; Salary ranges are based on level of experience and ability to meet quality expectations for caseload&middot; Ongoing professional development in a supportive environment&middot; Promotional opportunities - Connections believes in the talents of our team and promotes within&middot; Caseload resides in home and surrounding counties, reducing mileageConnections Case Management understands that employees are more than just case managers. They have families and lives outside of their professional careers. Our company values the health and well-being of our employees. We understand that if we provide supports that allow our employees to have a quality life at work and home, a good income and personal time away from work responsibilities, the return will be in quality supports for those they have on their caseload.Every employee does Case Management at Connections. The average caseload is 45 individuals. Each case manager is part of a smaller, regionally based team of 4-7 people which allows for direct quality support and monitoring by a supervisor. Additionally, your role as case manager is supported with an open and accessible team concept. Because Connections serves all 92 counties in Indiana, employees are encouraged to use all forums to connect with colleagues and utilize a team approach to Case Management.For more information about Connections Case Management please visit us at www.connectionsin.com where you can also download an application. Please also look us up on social media and check out our reviews on Glassdoor!Job Type: Full-timePay: $42,000.00 - $57,000.00 per yearBenefits:<ul><li>401(k)</li><li>401(k) matching</li><li>Dental insurance</li><li>Employee assistance program</li><li>Flexible schedule</li><li>Flexible spending account</li><li>Health insurance</li><li>Health savings account</li><li>Life insurance</li><li>Paid time off</li><li>Parental leave</li><li>Retirement plan</li><li>Vision insurance</li></ul>Work Location: On the road

Activities of Daily Living Behavioral Health

Join us in making a difference in the lives of those we serve by applying your skills as a Case Manager. Your expertise can help empower individuals and families on their journey toward stability and success.Case Manager Job DescriptionOverview:We seek a Case Manager to oversee client care and ensure quality outcomes and satisfaction.Responsibilities:- Manage care for up to 40 clients in Medicaid Waiver and Long Term Care programs.- Ensure Direct Support Workers (DSW) follow care plans and maintain client health.- Train, supervise, and evaluate DSWs.- Communicate with clients, families, and affiliates.- Conduct home visits quarterly, annually, and as needed.- Document client interactions and care changes.- Participate in after-hours on-call rotation and provide in-home backup support.Skills:- Experience in case management or related field preferred. Will train right candidate.- Experience with developmental disabilities preferred- Strong communication, organizational, and multitasking skills- Compassionate and team-orientedQualifications:- High School Diploma or equivalent- Current driver&rsquo;s license- Knowledge of HCBS rules and regulations preferredDetails: Full Time hours available- Salary: $14.00 per hour- High school diploma or equivalent preferred- Schedule: To be discussedJoin us and make a difference in our clients' lives!Job Type: Full-timeWork Location: In personJob Type: Full-timePay: From $14.00 per hourPeople with a criminal record are encouraged to applyWork Location: In person

Case Manager

Calling Care Services Inc.

Job Title: ACT Case Manager (Offsite / Field-Based Role)At Vivia Health, we bring compassionate, person-centered care directly to the community. Our Assertive Community Treatment (ACT) team serves adults living with serious and persistent mental illness (SPMI) across the Chicagoland area, helping them thrive in their own environments.We believe real progress happens outside clinic walls&mdash;in homes, libraries, stores, and community spaces. Our offsite model empowers mental health professionals to form meaningful relationships, promote recovery, and meet clients where they are, both physically and emotionally.Position OverviewWe are seeking a motivated and compassionate ACT Case Manager to join our multidisciplinary team. This is a 100% field-based position involving travel throughout Chicago to support clients in their homes and communities. You will help clients access essential resources, build daily living skills, and navigate barriers to independence.The ideal candidate is patient, empathetic, organized, and skilled in de-escalation and crisis prevention. You&rsquo;ll work independently in the field while staying connected to the ACT team through remote check-ins and virtual team meetings.Key Responsibilities<ul><li>Provide intensive, community-based case management services to adults with SPMI.</li><li>Travel to clients&rsquo; homes and community locations to engage, assess, and support them.</li><li>Assist clients with daily living needs such as grocery shopping, budgeting, and job applications.</li><li>Coordinate access to mental health care, housing, benefits, medical providers, and recovery services.</li><li>Support clients in crisis prevention and stabilization, using calm and effective communication.</li><li>Collaborate remotely with the ACT team&mdash;including psychiatrists, nurses, therapists, and peer specialists.</li><li>Maintain detailed, timely documentation in compliance with Medicaid and agency standards.</li><li>Promote recovery, independence, and dignity through consistent, person-centered engagement.</li></ul>QualificationsRequired:<ul><li>IM+CANS certification (Illinois Medicaid &ndash; Community and Supports Assessment).</li><li>Bachelor&rsquo;s degree in Social Work, Psychology, Human Services, or related field.</li><li>Minimum 1 year of experience working with individuals with serious mental illness.</li><li>Valid Illinois driver&rsquo;s license, auto insurance, and reliable personal transportation.</li><li>Strong interpersonal skills with the ability to build rapport and de-escalate challenging situations.</li><li>Comfortable working independently with mobile technology and electronic documentation.</li></ul>Preferred:<ul><li>Experience on an ACT team or in community-based mental health services.</li><li>Knowledge of Medicaid documentation and service coordination.</li><li>Bilingual (Spanish/English) candidates strongly encouraged to apply.</li></ul>Why Join Vivia Health?<ul><li>$1,000 Sign-On Bonus &ndash; payable after 90 days of successful employment.</li><li>100% Field-Based Role &ndash; no office shifts; true autonomy and flexibility.</li><li>Purpose-Driven Work &ndash; make a direct impact on Chicago&rsquo;s most vulnerable populations.</li><li>Collaborative Team &ndash; supportive ACT model with virtual team meetings and supervision.</li><li>Comprehensive Benefits &ndash; medical, dental, vision, PTO, 401(k), and mileage reimbursement.</li><li>Professional Growth &ndash; CEU reimbursement, continuous training, and clinical development opportunities.</li><li>Meaningful Relationships &ndash; help clients build stability, confidence, and life skills through real-world engagement.</li></ul>Pay: $25.00 - $32.00 per hourBenefits:<ul><li>401(k)</li><li>401(k) matching</li><li>Dental insurance</li><li>Employee assistance program</li><li>Health insurance</li><li>Health savings account</li><li>Life insurance</li><li>Mileage reimbursement</li><li>Paid time off</li><li>Vision insurance</li></ul>Application Question(s):<ul><li>Willing and prepared to work with individuals with complex mental health needs.</li></ul>Experience:<ul><li>Case management: 2 years (Required)</li></ul>Ability to Commute:<ul><li>Chicago, IL (Preferred)</li></ul>Willingness to travel:<ul><li>100% (Required)</li></ul>Work Location: On the road

Assertive Community Treatment Case Manager

RHA Health Services

<div>We are hiring for:
CAP Nurse Case Manager / RN / FT / Durham, Wake &amp; Orange Counties / Flexible Hours
Type:
Regular
If you are a positive and personable individual looking for a satisfying and fun opportunity to make a real difference in the lives of people with intellectual, developmental disabilities, and people facing mental health, and substance use challenges, join our team at RHA Health Services!
The CAP Nurse Manager works collaboratively with the CAP Social Worker, families, healthcare providers, and service providers ensuring the health, safety, and well-being of program participants. 
 
This position is responsible for conducting assessments, completing the annual multidisciplinary and Change of Status assessments, coordinating care, monitoring service delivery, and supporting the development of person-centered care plans. The RN ensures delivery of high-quality, individualized care in compliance with Medicaid guidelines and works closely with a multidisciplinary team to ensure high-quality care for participants.
Salary: $66,560.00
DUTIES AND RESPONSIBILITIES:<ul><li>
Assessment and Care Planning:<ul><li>
Conduct initial pre-screening and assessments of beneficiaries and their families to evaluate medical, psychological, behavioral, financial, social, cultural, environmental, legal, vocational, educational, and other areas.</li><li>
Consult with the CAP beneficiary and primary caregiver to educate about waiver services, Medicaid, and community resources to meet the beneficiaries' needs.</li><li>
Identify needs to prevent health and safety factors to assist in maintaining community placement.</li><li>
Develop and maintain individualized, person-centered care plans (emergency and disaster planning) to ensure the health, safety, and well-being of beneficiaries.</li><li>
Update care plans at least every 12 months or when the status of the beneficiary changes.</li><li>
Ensure beneficiaries and families understand the plan of care to make informed decisions</li></ul></li><li>
Service Coordination:<ul><li>
Coordinate services such as personal care, waiver supplies, home modifications, and educational support in alignment with the care plan.</li><li>
Collaborate with the team to monitor service quality and ensure compliance with Medicaid and program standards.</li><li>
Arrange for additional services as needed to prevent institutionalization and support participants in their homes.</li></ul></li><li>
Monitoring and Follow-Up:<ul><li>
Monitor services through monthly phone calls and home visits, document observations and beneficiary progress.</li><li>
Evaluate the effectiveness of care plans and services, recommending or implementing changes as needed to achieve desired outcomes.</li></ul></li><li>
Counseling and Support:<ul><li>
Provide emotional support and counseling to beneficiaries and their families to strengthen their support systems.</li><li>
Assist families in navigating challenges, including long-term palliative care, behavioral issues, and medical needs.</li></ul></li><li>
Documentation and Compliance:<ul><li>
Assist with obtaining documentation from medical staff to confirm the need for specific CAP services.</li><li>
Maintain accurate and up-to-date records for all participants in accordance with Medicaid and program requirements.</li><li>
Ensure compliance with 10A NCAC 27G.0202 and other regulatory guidelines.</li><li>
Review and ensure proper billing codes and compliance for case management, in-home aide documentation, paid live-in caregiver, re-certifications, and supply billing.</li><li>
Participate in NC Medicaid-certified training programs and ensure program compliance within 90 days of employment.</li><li>
Ensure timely updates to the CAP Business system and other documentation systems as required.</li></ul></li><li>
Collaboration and Advocacy:<ul><li>
Work closely with SWs and interdisciplinary team members to ensure a comprehensive approach to beneficiary care.</li><li>
Act as an advocate for program participants and their families to secure necessary resources and services.</li><li>
Work closely with service providers, community agencies, and healthcare professionals to optimize care outcomes.</li><li>
Provide training and support to families to empower them in managing their child&rsquo;s care.</li></ul></li><li>
Continuing Education and Professional Development:<ul><li>
Complete all state-mandated training and agency-required continuing education annually.</li><li>
Stay current on CAP guidelines, best practices, and new developments to enhance service delivery.</li></ul></li><li>
All other duties as assigned.</li></ul>
SUPERVISORY RESPONSIBILITIES:
This position has no supervisory responsibilities.
MINIMUM QUALIFICATIONS:<ul><li>
Strong understanding of Medicaid programs and compliance requirements.</li><li>
Excellent communication and interpersonal skills to work effectively with families and multidisciplinary teams.</li><li>
Ability to manage multiple priorities and maintain detailed records.</li><li>
Experience working with medically fragile children or in pediatric healthcare settings and physically disabled adults with complex care needs.</li></ul>
Education and Experience:
Candidates must meet one of the following criteria:
Nursing Background:<ul><li>
Current North Carolina Registered Nurse (RN) license with a two-year or four-year degree.</li><li>
One year of case management experience in home care, long-term care, personal care, or related work.</li><li>
Completion of an NC Medicaid-certified training program within 90 calendar days of employment.</li></ul>
Note: An individual with a bachelor&rsquo;s degree or who holds a nursing license as described above, without the number of years of experience, may be designated as an apprentice and shall be hired to act in the role of case manager. The supervisor of the case management shall provide direct supervision and approve all CAP/C workflow documentation and tasks.
PHYSICAL DEMANDS AND WORK ENVIRONMENT:<ul><li>
Must be able to lift a minimum of 10 lbs.</li><li>
Must be able to pull a minimum of 20 lbs.</li><li>
Must be able to squat, kneel, crawl, crouch, climb, and stoop.</li><li>
Required to regularly stand and walk.</li></ul>
RHA is an Equal Employment Opportunity Employer, prohibits discrimination based on the following protected categories: race, creed, color, national origin, nationality, ancestry, age, sex/gender, marital status, civil status, domestic partnership status, familial status, religion, affectional or sexual orientation, gender identity or expression, atypical hereditary cellular or blood trait, genetic information, liability for service in the Armed Forces of the United States, or disability.
Pre-employment screening:<ul><li>
Complete criminal background</li><li>
Name checked in the registries. (OIG exclusions database, Child Abuse Registry, and Offenders Against Individuals with Developmental Disabilities)</li><li>
Drug testing</li><li>
Education verification and other credentialing based on position requirements.</li><li>
Proof of employment history or references (if required)</li><li>
Positions that require driving Proof of driver's license, driver's insurance, and vehicle, IF required for providing transportation for individuals.</li></ul>
We offer the following benefits to employees:<ul><li>
Payactiv: early access to the money you&rsquo;ve earned from hours you&rsquo;ve already worked, before payday!</li><li>
Employee perks and discount program: to help you save money!</li><li>
Paid Time Off (full-time employees only)</li><li>
Health/Insurance (full-time employees only)</li><li>
401(k) retirement savings program
</li><li>Wellbeing Programs: Physical, Emotional and Financial</li><li>
Chronic Disease management programs for hypertension and diabetes (for qualifying employees)</li><li>
Training: Free CPR, first aid, and job-specific training opportunities</li><li>contract/contingent workers and interns do not qualify for any of the above benefits</li></ul>
EEO Statement RHA is an equal opportunity employer. In addition, we provide reasonable accommodation to qualified employees who have protected disabilities to the extent required by applicable laws, regulations, and ordinances. If you are an individual with a disability and need a reasonable accommodation to participate in the application process, please contact our solutions center.
About RHA:
At RHA Health Services, we help individuals with intellectual and developmental disabilities, mental health and/or substance use needs live their best lives. Our mission is to provide a safe and healthy environment while creating opportunities for personal outcomes.
For over 30 years, the people we serve and support have remained at the very center of everything we do. RHA currently provides services in North Carolina, Georgia, Pennsylvania, Tennessee, and New Jersey.
If you are ready to make a difference in the lives of people we serve and support apply to join the team today.</div>

CAP Nurse Case Manager / RN / FT / Durham, Wake & Orange Counties / Flexible Hours

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CAP Nurse Case Manager / RN / FT / Durham, Wake & Orange Counties / Flexible Hours