Medicaid Waiver Case Manager

Summary description

The Medicaid Waiver Case Manager is responsible for implementation of the Medicaid Waiver Home and Community-based Services Program within the SARPC area following specific requirements as set out in Medicaid Waiver guidelines.

Supervisory controls

Receives general instructions from the Medicaid Waiver Team Lead. Supervisor sets limitations, quality and quantity expected, deadlines and priorities; employee uses initiative in carrying out assignments; and work is checked for technical accuracy.

Responsibilities

AND DUTIES: 1. Establish referral sources by disseminating information to organizations, agencies, and individuals. Receive and respond to verbal and written referrals of eligible Medicaid recipients in order to obtain information on potential Medicaid clients and to provide information to referral sources. 2. Conduct and prepare on-site assessments on potential clients in order to enroll them in the Medicaid Waiver Program. Submit completed forms to the appropriate state agency and follows up on status of the same in order to fill the number of slots allowed by the Alabama Medicaid Agency in a timely manner. 3. Authorize contractors to initiate services after receiving notification of approval from Alabama Medicaid Agency, and forward appropriate copies of assessments, care plans, and service authorization forms to the respective contractors. Visit contractors’ offices and exchanges information with appropriate personnel to ensure that the contractors are operating as outlined in guidelines. 4. Develop, monitor, and revise client’s care plan in coordination with client/caregiver to fit the needs of the client. Conduct monthly visits to clients’ homes and evaluate the services being provided by the Medicaid Waiver Program to ensure the services are appropriate, adequate, and of acceptable quality. Prepare case notes of visits and evaluations for documentation to be placed in case files. 5. Check monthly billings submitted by contractors for services rendered to clients in order to determine that the billing is accurate and the claims are in conformity with the clients’ Care Plans. Monitor the cost effectiveness of Waiver services for each client. 6. Conduct yearly redetermination assessments on clients as outlined in Medicaid Waiver guidelines and completes HCBS forms in order to meet requirements prescribed by the Alabama Medicaid Agency. 7. Compose and maintain the following reports as necessary: HCBS Program Case Management Activity Record and Case Managers Daily Time Logs. 8. Exchange information with Medicaid Waiver clerical staff through written and verbal communication in order to assign work and follow up on tasks. 9. Other duties as assigned.

Knowledge, skills, and abilities required

1. Knowledge of social work programs and processes. 2. Knowledge of community resources and support network available to clientele served. 3. Excellent communications skills, both orally and written. 4. Ability to relate to the elderly and their unique problems. 5. Knowledge and ability to write and print legibly. 6. Knowledge and ability to operate office equipment including telephone, copy machine, fax machine, computer, and calculator. 7. Knowledge and ability to do basic arithmetic. 8. Ability to read and interpret guidelines and regulations and apply them to the job. 9. Completion of initial case manager’s training within three (3) months of employment. 10. Bachelor’s Degree from an accredited four-year college or university in Social Work, Behavioral Sciences, Psychology, Geriatric Studies, or a related field. At least three (3) months of work experience in a social work or related program. 11. A valid driver’s license and a good driving record.

Work conditions

The work requires some physical exertion such as long periods of standing; walking over rough, uneven, or rocky surfaces; recurring bending, crouching, stooping, stretching, reaching, or similar activities; recurring lifting of moderately heavy items such as record boxes. This position requires driving on a regular basis.

Supervisory responsibilities: None