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.