Waiver Case Manager

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 role involves conducting clinical and general case management and managing the financial aspects of care plans to ensure client needs are met in a timely and professional manner while maintaining client confidentiality.

Responsibilities Participant Directed Services (PDS) and Traditional Waiver Case Management

• 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.
• Conduct eligibility checks at the beginning of each month to verify that each client is Medicaid eligible and remains active.

Electronic Visit Verification (EVV)

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

Other Duties

Assist with 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;
• Bachelor’s degree in any field not closely related and one year human services related experience;
• Associate degree in a behavioral science, social science, or closely related field and two years human services related experience;
• Three years of human service related experience;
• 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;
• Master’s degree in a health or human services field from an accredited college or university.

Certification & Trainings

• Valid driver’s license required.
• Negative Tuberculin (TB) skin test required.
• Obtain CPR/First Aid certification within six months of hire date and maintain thereafter.
• 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, Sensory, & Working Conditions

• Sit for extended periods of time; stand and walk for extended…