Medicaid Waiver Nurse

Medicaid Waiver Nurse

Starting Salary Range: $63,011 - $75,613

This position determines eligibility for the Medicaid Waiver program in compliance with Federal and State regulations. This position also provides trainings to and consultation to case managers on eligibility requirements.

Responsibilities:

• Determine Medicaid Waiver eligibility for individuals supported by GGRC as required by the Department of Developmental Services (DDS) regulations. Review case records to assure assessed needs are supported by current case documentation and collaborate with Case Manager as needed to assure Client Development Evaluation Report (CDER) is updated and accurate and that the Consumer Choice form is received and filed to e-records.
• Determine Medicaid Waiver eligibility for Institutional Deeming Referrals to Medi-Cal. Receive, process, and track referrals and follow up with Case Manager.
• Perform annual recertification review for persons enrolled in the Medicaid Waiver program.
• Perform Medicaid Waiver terminations when eligibility requirements are no longer met.
• Distribute Medicaid Waiver documentation for data entry and filing to e-records.
• Review and compare State and Regional Center reports to ensure accuracy of data.
• Provide assistance during Federal and State audits and follow up on an appropriate plan of corrective action as needed.
• Inform, educate and provide input to case management staff and others regarding Medicaid Waiver program, documentation, and any changes in Medicaid Waiver status of individuals served. Assist with the new hire orientation sessions to Medicaid Waiver and ongoing training for case management staff.
• Establish and maintain relationships with external organizations including DDS and County Health and Human Services offices to facilitate the exchange of information between the agency and its community partners.
• Participate in related projects, and assist with additional duties or tasks, as assigned.
• Maintain all information related to individuals supported as confidential in compliance with the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the California Lanterman Act.

Requirements

• Education/Experience
• Bachelor’s Degree from an accredited school in Nursing. Master’s Degree preferred.
• Valid Registered Nurse License at time of hire and ability to maintain license in good standing.
• 2+ years in a variety of hospital and/or community settings
• Experience with individuals with developmental disabilities and determining quality assurance is preferred.
• Experience in multi-cultural settings and/or multi-lingual capacity is preferred.
• Competencies
• Strong organizational skills
• Time management
• Attention to detail
• Collaboration/teamwork
• Customer service orientation; Demonstrate respect and cultural awareness; effectively manage own reactions
• Initiative and follow through
• Adaptability
• Ability to multi-task with competing priorities
• General Skills
• Knowledge of principles, methods and procedures of current nursing health practices, epidemiology, methods of developmental assessment and intervention and the ability to recognize changes in level of care.
• Ability to extract and analyze pertinent information from a variety of sources including internal and external medical records and case notes.
• Ability to interpret and apply federal, state and county eligibility regulations and agency procedures.
• Ability to communicate complex information and ideas in a clear, concise and professional manner verbally and in writing.
• Ability to operate basic office equipment, including scanners, copiers, faxes, phones.
• Basic familiarity with MS Word, MS Excel, MS PowerPoint, MS Outlook or similar software applications.
• Organizational skills; attention to detail, initiative and follow-up.
• Ability to identify and assist in the resolution of operational difficulties.
• Build partnerships and trust through collaboration, active listening and an openness to new ideas.
• Act quickly and decisively in a crisis.
• Understand and effectively react/adapt to multiple and competing priorities on the job.
• Use knowledge and expertise to focus on key job outcomes
• Demonstrate respect and cultural awareness
• Experience in multi-cultural settings and/or multi-lingual capacity