CAP Nurse Case Manager (RN) / FT / Buncombe & Madison Counties / Flexible Hours

About the role

We are hiring for: CAP Nurse Case Manager (RN) / FT / Buncombe & Madison Counties / Flexible Hours

Responsibilities

• Assessment and Care Planning: Conduct initial pre-screening and assessments of beneficiaries and their families to evaluate medical, psychological, behavioral, financial, social, cultural, environmental, legal, vocational, educational, and other areas. Consult with the CAP beneficiary and primary caregiver to educate about waiver services, Medicaid, and community resources to meet the beneficiaries' needs. Identify needs to prevent health and safety factors to assist in maintaining community placement. Develop and maintain individualized, person-centered care plans (emergency and disaster planning) to ensure the health, safety, and well-being of beneficiaries. Update care plans at least every 12 months or when the status of the beneficiary changes. Ensure beneficiaries and families understand the plan of care to make informed decisions.
• Service Coordination: Coordinate services such as personal care, waiver supplies, home modifications, and educational support in alignment with the care plan. Collaborate with the team to monitor service quality and ensure compliance with Medicaid and program standards. Arrange for additional services as needed to prevent institutionalization and support participants in their homes.
• Monitoring and Follow-Up: Monitor services through monthly phone calls and home visits, document observations and beneficiary progress. Evaluate the effectiveness of care plans and services, recommending or implementing changes as needed to achieve desired outcomes.
• Counseling and Support: Provide emotional support and counseling to beneficiaries and their families to strengthen their support systems. Assist families in navigating challenges, including long-term palliative care, behavioral issues, and medical needs.
• Documentation and Compliance: Assist with obtaining documentation from medical staff to confirm the need for specific CAP services. Maintain accurate and up-to-date records for all participants in accordance with Medicaid and program requirements. Ensure compliance with 10A NCAC 27G.0202 and other regulatory guidelines. Review and ensure proper billing codes and compliance for case management, in-home aide documentation, paid live-in caregiver, re-certifications, and supply billing. Participate in NC Medicaid-certified training programs and ensure program compliance within 90 days of employment. Ensure timely updates to the CAP Business system and other documentation systems as required.
• Collaboration and Advocacy: Work closely with SWs and interdisciplinary team members to ensure a comprehensive approach to beneficiary care. Act as an advocate for program participants and their families to secure necessary resources and services. Work closely with service providers, community agencies, and healthcare professionals to optimize care outcomes. Provide training and support to families to empower them in managing their child’s care.
• Continuing Education and Professional Development: Complete all state-mandated training and agency-required continuing education annually. Stay current on CAP guidelines, best practices, and new developments to enhance service delivery.

Qualifications

• Strong understanding of Medicaid programs and compliance requirements.
• Excellent communication and interpersonal skills to work effectively with families and multidisciplinary teams.
• Ability to manage multiple priorities and maintain detailed records.
• Experience working with medically fragile children or in pediatric healthcare settings and physically disabled adults with complex care needs.
• Education and Experience: Candidates must meet one of the following criteria: Nursing Background: Current North Carolina Registered Nurse (RN) license with a two-year or four-year degree. One year of case management experience in home care, long-term care, personal care, or related work. Completion of an NC Medicaid-certified training program within 90 calendar days of employment.