Case Manager – Medicaid waiver

SOC Code: 21-1093
Department:
Medicaid waiver

Reports to:

Medicaid waiver Program Supervisor
Analysis Completed:
July 2016

The Medicaid waiver Case Manager assists individuals in gaining access to appropriate, needed, and desired waiver and other State Plan services, as well as needed medical, social, educational, and other appropriate services. The position serves to provide necessary coordination with direct service providers (DSP) of non-medical, non-waiver services when the services provided by these entities are needed to enable the client to function at the highest attainable level or to benefit from programs for which clients might be eligible.

The Case Manager reports to the Medicaid waiver Supervisor.

• Prepares personal work plan to meet departmental objectives and expectations; schedules office and field activities to include data collection, research, and meetings.
• Assists Program Supervisor as needed.
• Communicates with client, caregivers, service providers, and physicians on a regular basis.
• Completes and submits required paperwork in a timely manner. Must meet deadlines.
• Responsible for maintaining orderly, confidential files.
• Conducts verification of monthly service billing and eligibility.
• Attends and participates in monthly staff meetings.
• Communicates with Assistant Supervisor and Program Supervisor on a regular basis to ensure caseload work is being met.
• Prepares and submits daily activity log.

• Maintains a caseload of 35-40 clients each month.
• Executes ongoing monitoring of the provision of waiver and non-waiver services including the individual’s Plan of Care.
• Conducts intake and screening of clients.
• Authorizes initial waiver services and determines continued eligibility.
• Determines level of care.
• Determines choice of institution or community care.
• Develops plan of care based on individual needs.
• Coordinates, monitors, changes, re-determines, level of services.
• Authorizes termination of services or case transfer/termination.
• Makes monthly visit to client to ensure level of care is being upheld. Responsible for other required home visits when needed.
• Responsible for in depth record keeping including documenting monthly visits and keeping daily logs.
• Maintains regular contact with clients and advocates for their rights within scope of services.
• Facilitates crisis intervention.
• Provides guidance and support for clients, client’s families, and staff.
• Ability to communicate in a collaborative, effective manner with others and to maintain good working relationships.
• Ability to comprehend basic medical terminology.
• Possess knowledge of Medicaid waiver programs and service providers.
• Flexibility. Workload may include working before or after normal business hours.
• Communication Proficiency. Both written and oral.
• Personal Effectiveness/Credibility.
• Strong interpersonal skills.
• Project Management.
• Critical thinking and deductive reasoning skills.
• Ability to maintain high degree of confidentiality.
• Microcomputer skills to preform word processing and spreadsheet analysis, use databases and software, use e-mail, and access the internet.
• Experience with Microsoft Office programs (Word, PowerPoint, and Excel).
• Ability to interpret and communicate complex rules and regulations.
• Ability to work towards objectives with little supervision.
• Strong time management skills. Ability to meet deadlines.

Bachelor’s Degree from an accredited college or university in human services related field (preferably in social work). At least 2 years of professional experience in the human services field preferred. Knowledge of Medicaid programs and experience working with elderly and disabled people preferred.
-OR
- Master’s Degree in Social Work.
Licensed Clinical…