Medicaid Waiver Case Manager

Case Manager

Imagine a place where your talent can make a difference in people’s lives. Working at MountainHeart Community Services, Inc. is a rewarding experience in which our employees work together as vital parts of a bigger mission. We are collaborative, innovative, mission-driven, and focused on results. It is time that you join our team!

Benefits of working for MountainHeart Community Services, Inc.

We offer a variety of social programs, flexible work hours and family-friendly benefits

4-day work week

Health insurance is available on a cost-sharing basis for employee and families – Employer pays 75% of premium

Profit Sharing Retirement Plan – Employer contributes 10% of your salary

Dental Insurance – Employer pays 100% of the premium for employee and families

Access to supplemental insurances, i.e. short-term disability, accident etc.

Access to Vision Insurance

Basic Life Insurance

Optional Life Insurance

Dependent Life Insurance

EAP – Employee Assistance Program

Twenty - Paid holidays

Case Manager

Full-time (36 hours a week)

Location: Raleigh/ Mercer County

Salary: $20.00 - 22.00 / hour

Benefits: Full Benefits

Summary: Responsible for following up with the person receiving ADW services to ensure that services are being provided as described in the Service Plan. To complete and submit all required administrative and program reports as requested by either BMS or the OA. Initial contact with new participants must be made within seven calendar days after Personal Attendant services have begun, via telephone or face-to face.

Essential Duties and Responsibilities

• Assure financial eligibility remains current.
• Submit the MNER in accordance with policy.
• Address changing needs of the person as reported by them (or legal representative), Personal attendant staff and/or RN, Resource Consultant, if applicable or informal supports.
• Address changing needs determined by the monthly telephone contact.
• Refer and procure an additional services or resources needed.
• Coordinate with all current service providers to develop the six month Service Plan and the Annual Service Plan, or more often as necessary.
• Provide the Service Plan to all applicable service providers including TMH Transition Navigators that are providing services to the person.
• Provide copies of all necessary documents to the person receiving ADW services.
• Annually submit a Medical Necessity Evaluation Request to the UMC.
• Submit WV Personal Care Request for Dual Services as needed.
• Upload documents into the UMC web portal.
• Assist with filing grievances, complaints, fair hearing request.
• Assist with obtaining legal representation when needed, such as medical power of attorney, health care surrogate, etc.
• Ensure services were provided in accordance with the Service Plan.
• Evaluate social, environmental, service, risks, and support needs of the individual
• Develop and write an individualized Service Plan.
• Coordinate the delivery of care, eliminate fragmentation of services, and assure appropriate use of resources.
• Proactively identify problems and coordinate services that provide appropriate high

Quality care to meet the individualized and often complex needs of the person.

• Provide advocacy on behalf of the person to ensure continuity of services, system flexibility, integrated services, proper utilization of facilities and resources, and accessibility to services.
• Ensure that a person's (or legal representative) wishes and preferences are reflected in the development of the Service Plan by working directly with the person (or legal representative and all service providers.
• Assure that a person's legal and human rights are protected. Make Fraud an/Abuse/Neglect referrals as needed.
• Follows up on all service delivery concerns within two business days and documentations in the WV IMS.
• Perform any and all duties incidental to the position.
• Must maintain confidentiality at all times.

Supervisory Responsibilities:

This position has supervisory responsibilities.

Competencies:

To perform the job successfully, an individual should demonstrate the following competencies:

Quantity -Complete work in a timely manner; work quickly.

Safety and Security -Observe safety and security procedures; report potentially unsafe conditions; use equipment and materials properly.

Attendance/Punctuality - Be at work when scheduled and on time.

Dependability - Follow instructions, respond to management direction. Ability to work independently.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements described are representative of the knowledge, skills, and/or ability required. Computer skills including knowledge of Microsoft Word and Excel, excellent communication skills, and ability to use office equipment. Must have good recall memory, typing, organizational and listening skills. Must be self-disciplined and highly motivated with a desire to learn.

Education and/or Experience:

This position requires a West Virginia Social Worker License, Counselor, or Registered Nurse

Must have a valid West Virginia driver’s license, clear criminal background and APS/CPS check. Must have dependable transportation and be able to use personal vehicle for business purposes.

Language Skills:

Ability to write reports and other written communication. Ability to effectively present information and respond to questions from managers, clients, customers, and the public.

Job Type: Full-time

Pay: $20.00 - $22.00 per hour

Benefits:

• 401(k) matching
• Employee assistance program
• Flexible spending account
• Retirement plan

Schedule:

• Day shift

Work Location: In person

Salary : $20 - $22