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Waiver Case Manager Per Visit

2 months ago

Louisville, United States Caretenders - Louisville Waiver Full time

We are hiring a Waiver Case Manager for Visits in and around Louisville, KY.

  • Experience working with Aging and/or Disabled Clients
  • One year minimum knowledge of Medicaid Waiver Process
  • Flexible Scheduling
  • Earn PTO while working 32+ Hours per Week

At Almost Family Home and Community Based Services, a part of LHC Group, we embrace a culture of caring, belonging, and trust and enjoy the meaningful connections that come from it: for the whole patient, their families, each other, and the communities we serve-it truly is all about helping people. You can find a home for your career here.

As a Waiver Case Manager, you can expect:

  • Flexibility for true work-life balance
  • Opportunities for career growth
  • The ability to build trusted patient relationships
  • Employee-focused wellness and support programs

If you love caring for people and want to strengthen your experience, this is a great opportunity for you.


Job Summary

Coordinates the integration of Case Management / Social Services functions for client's participating in a waiver program in Kentucky. The Case Manager is responsible to lead a collaborative process which assesses, plans, implements, coordinates, monitors, and evaluates available services on an ongoing basis to meet the client's health care needs. Acts as a patient advocate, performs staff education related to resource utilization, and discharge planning.

Education and Experience

License Requirements A bachelor's or master's degree in a health and human service field and at least (1) year experience in a health and human service field or the educational equivalent in the field of aging or disabilities or be a Kentucky licensed registered nurse with at least (2) years of experience in the field of aging or disability or a master's degree in health or human services field.

  • Responsible for performing case management functions for Kentucky Waiver programs.
  • Complete timely initial visit to clients to explain waiver program.
  • Communicate in a way that ensures the best interest of the client.
  • Responsible for identifying the needs of the client and ensure needs are met.
  • Educate the client and/or client representative regarding the case management process, personal rights, risks and responsibilities, and available resources.
  • Lead the person-centered service planning team and take charge of coordinating and monitoring services through team meetings with all service providers and participants of the client's person-centered service plan.
  • Ensure participation of the client and/or client's legal representative in the case management process.
  • Assess the quality of services, safety of services, and cost effectiveness of services being provided to the client to ensure the success and efficiency of the person-centered care plan.
  • Review and coordinate client's eligibility in Kentucky Medicaid Waiver.
  • Ensure reassessment is completed by the Department for Medicaid Services to maintain member eligibility prior to level of care end date.
  • Ensure accurate updating of the client's status in the Medicaid Waiver Management Application (MWMA) including (but, not limited to): termination from program, admitted to the hospital or skilled nursing facility, transferred to an alternate waiver program, or relocation of residence.
  • Complete all appropriate Medicaid waiver forms and documentation and submit through the Medicaid Waiver Management Application (MWMA).
  • Ensure client and/or client representative is provided information about participant direct services at the time of the initial person-centered care plan, at least annually thereafter, and upon inquiry from the client and/or client representative.
  • Complete all case notes in the MWMA.
  • Maintain Participant Directed Service (PDS) employee paperwork and chart, as applicable.
  • Train PDS employees and clients, as applicable.
  • Work with PDS Manager to assure client's needs are being met.
  • Assure Prior Authorization letters are received for billing.
  • Direct waiver referrals, in a timely manner, to the Aging and Disability Resource Center (ADRC) staff.
  • Advocate on behalf of the client and family with appropriate community resources.
  • Monthly home visits/phone calls to monitor service delivery and progress toward member's goals.
  • Work closely with traditional provider agencies, local Department for Community Based Services, Department for Aging and Independent Living, and Department for Medicaid Services.
  • Work with clients to solve eligibility issues.
  • Monitor client budget to assure client is within guidelines.
  • Issue a client corrective action plan if client does not comply with the person-centered service plan, as applicable.
  • Provide conflict-free case management or ensure completion of exemption, as applicable.
  • Follow all organizational policies and procedures.
  • Supports and participates in the Quality and Performance Improvement program.
  • Supports and complies with organization's Corporate Compliance program.
  • Attends and completes all in-service and education requirements of the organization.
  • Completes all other duties as assigned.

License Requirements

  • A bachelor's or master's degree in a health and human service field and at least (1) year experience in a health and human service field or the educational equivalent in the field of aging or disabilities or be a Kentucky licensed registered nurse with at least (2) years of experience in the field of aging or disability or a master's degree in health or human services field.

Skill Requirements

  • Broad knowledge base of special needs groups, community groups, and service organizations.