Medicaid Waiver Manager

Job Description

Job Description

QUALIFICATIONS :

Minimum qualifications include an RN with a BA / BS degree in nursing from an accredited college / university and a California Public Health Certification or a master’s degree from an accredited college / university in socia1 work, human services, public health, public administration, or related field along with a valid California Driver’s License are required.

Must have five years of related experience and / or training in the areas of federal and state benefit programs; developmental disabilities;

knowledge of ICD9-CM diagnostic criteria and other medical conditions.

ESSENTIAL DUTIES AND RESPONSIBILITIES :

Under the direction of the Director of Clinical Services, the Medicaid Waiver Manager’s position will act as SCLARC’s Federal Revenue Coordinator, enable the State to receive federal funding and ensure SCLARC’s program compliance with the state and federal laws and regulations.

The candidate is responsible for supervising the Medicaid Waiver Specialist staff and the Medicaid Waiver nurse consultants.

Responsible for coordinating all state and federal benefit programs for SCLARC consumers, such as Medicaid Waiver, PRUCOL, Early and Periodic Screening Diagnostic Treatment (EPSDT), Institutional Deeming, and Nursing Home Reform.

Assists with the completion of annual HCBS waiver enrollment, recertification, and termination of Medicaid waiver eligibility.

Ensures CDER data integrity, reviews and determines billable services, choice statements and reconciles Medicaid waiver data.

Maintains records in accordance with applicable federal requirements for accuracy and completeness, reviews case records for eligibility to the DDS Medicaid C Waiver, SDP Waiver, and the Institutional deeming program.

Responsible for developing and participating in training sessions on HCBS waiver policies and procedures. Participates in ARCA Federal Revenue Coordinator Committee meetings, Regional Center and other community meetings.

Provide staff training and technical assistance to service providers and work with case management staff to ensure timely certifications and recertification of federal programs for consumers.

Must have the ability to interpret regulations and mandates as well as write policies and procedures. Ongoing tasks and training related to Target Case Management (TCM).

Organizes, prepares and is the lead person for DDS monitoring reviews. Must have the ability to maintain a working relationship with the Department of Developmental Services.

Qualified candidates must possess excellent interpersonal skills and be able to work with interdisciplinary and multidisciplinary clinical and case management teams.

Good written and verbal communication skills as well as the ability to compile and analyze statistical data. Must possess proficient computer skills with knowledge of Microsoft Word, PowerPoint, and Excel.