Waiver Case Manager

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.

General Duties and Responsibilities:

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;
• Develop, maintain, modify, and review a Plan of Care for each client;
• 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.

Electronic Visit Verification (EVV): 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.

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

Qualifications:

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 sociology. Relevant experience may include experience as a case manager or in a related human services field, Certified Nursing Assistant experience, Certified Medical Assistant experience, Certified Home Health Aide experience, Personal Care Assistant experience, assessment and care planning experience with clients, or other paid professional experience with aging and/or disabled populations or programs.

Certification and Trainings:

• Valid Driver's License required. Negative Tuberculin (TB) skin test required. Obtain CPR/First Aid certification within six months of hire date and maintaining certification thereafter. Employees will be expected to attend professional development trainings related to programs and services provided within the Aging & Independent Living Department. Registered Nurses must maintain a valid license as a condition of continued employment.

Experience:

• Entry Level Position. One (1) year of related experience and/or related internship preferred.

Physical Requirements:

• Sit for extended periods of time; stand and walk for extended periods of time; reach, stoop, crouch, bend; ability to lift and carry approximately 30 pounds; fine motor skills; and operate a vehicle.

Sensory Requirements:

• Sight; Hearing; Speaking

Working Conditions:

• Indoor office conditions; outdoor conditions during various weather conditions and on various terrains; possible wildlife/animal encounters during home visits; requires intermittent standing, sitting, or stooping; work requires consistent use of computer and phone systems as well as other general office equipment; and frequent interruptions.

Availability and Travel:

• Normal business hours; nights/weekends (special events/training/local meetings); and regular travel within region and state.

Tools, Equipment, and Vehicle Use:

• Standard office equipment (computers, printers, scanners, phones, etc.); and fleet/personal vehicle(s).

Knowledge, Skills, and Abilities:

• Knowledge:
• Federal and state programs and guidelines for the elderly and disabled;
• Record keeping and reporting requirements;
• Waiver policies and procedures as regulated by the Department for Aging and Independent Living and the Department for Medicaid Services;
• Formal and informal resources available for the elderly and disabled; and
• Non-profit operations, organizations, functions, and challenges.

Skills:

• Oral and written communication;
• Microsoft Office Suite (Word, PowerPoint, Excel);
• Attention to detail;
• Use of computers and other office equipment;
• Reasoning, problem-solving, and organization;
• Analytical skills;
• Establishing and sustaining interpersonal relationships; and
• Organizing and maintaining accurate files and records.

Abilities:

• Be present and punctual;
• Prioritize work and meet deadlines;
• Work under stressful situations with patience and tact;
• Teamwork;
• Administer federal and state-funded programs;
• Identify workload, be flexible, and prioritize changing workloads;
• Prepare and maintain accurate records;
• Establish and maintain effective working relationships with funding agencies, contractors, officer, and employees of the organization; and
• Maintain confidentiality.

This position will remain open until filled.

Gateway Area Development District is an Equal Opportunity Employer M/F/D/V.

About Gateway Area Development District:

Gateway Area Development District (GADD) is the regional council of government and federally designated Area Agency on Aging and Independent Living, along with the federally designated Economic Development District by the Economic Development Administration, serving Bath, Menifee, Montgomery, Morgan, and Rowan Counties in east-central Kentucky since 1969. GADD is governed by a Board of Directors comprised of elected officials from the counties and communities within the region as well as non-elected citizen members representing the region's social and economic institutions. GADD board and staff are committed to the regional planning, promotion, and coordination of programs for community, infrastructure, economic, and social development.