Medicaid Waiver Nurse

Golden Gate Regional Center Inc; San Francisco (CA); On-site; USD 63,011 - 75,613; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Life insurance

Disability insurance

Vision coverage

403(b) retirement plan

Generous paid time off

Job summary

Golden Gate Regional Center Inc is seeking a Medicaid Waiver Nurse to determine Medicaid Waiver eligibility and provide training to case managers on eligibility requirements. The position involves reviewing records, processing referrals, conducting annual recertifications, and maintaining compliance with HIPAA and Lanterman Act.

The role requires a BSN, RN license in good standing, and at least 2 years of hospital or community experience, with preference for those familiar with developmental

Qualifications

• Bachelor’s Degree in Nursing from an accredited school; Master’s Degree preferred.
• Valid Registered Nurse License in good standing at time of hire.
• At least 2 years of experience in hospital and/or community settings.
• Experience with individuals with developmental disabilities preferred.
• Experience in multicultural settings or multilingual capacity preferred.

Responsibilities

• Determine Medicaid Waiver eligibility for individuals supported by GGRC.
• Review case records and collaborate with Case Managers for accurate reports.
• Process and track referrals for Medi-Cal deeming and follow up.
• Perform annual recertification reviews for Medicaid Waiver participants.
• Terminate Medicaid Waiver eligibility when criteria are not met.
• Distribute documentation for data entry and filing to e-records.
• Review State and Regional Center reports for data accuracy.
• Assist during audits and address corrective actions.
• Educate and advise case management staff on the Medicaid Waiver program and changes.
• Assist with new‑hire orientation sessions for Medicaid Waiver staff.
• Establish relationships with DDS and County HHSA to exchange information.
• Participate in related projects and other duties as assigned.
• Maintain confidentiality per HIPAA and Lanterman Act.

Skills

Organizational skills

Time management

Attention to detail

Collaboration

Customer service orientation

Cultural awareness

Education

Bachelor’s Degree in Nursing

Master’s Degree preferred

Tools

MS Word

MS Excel

MS PowerPoint

MS Outlook

Job description

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. It also provides training 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, reviewing case records and collaborating with Case Managers to ensure accurate Client Development Evaluation Reports and filed Consumer Choice forms.
• Determine Medicaid Waiver eligibility for Institutional Deeming Referrals to Medi-Cal, receive, process, and track referrals, and follow up with Case Managers.
• Perform annual recertification reviews for persons enrolled in the Medicaid Waiver program.
• Conduct 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 data accuracy.
• Provide assistance during Federal and State audits and follow up on corrective action plans.
• Inform, educate, and advise case management staff and others regarding the Medicaid Waiver program, documentation, and status changes.
• Assist with new‑hire orientation sessions for 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 information exchange.
• Participate in related projects and perform additional duties as assigned.
• Maintain confidentiality of all information related to individuals supported, in compliance with HIPAA and the California Lanterman Act.

Education/Experience

• Bachelor’s Degree in Nursing from an accredited school; Master’s Degree preferred.
• Valid Registered Nurse License at time of hire with ability to maintain license in good standing.
• At least 2 years of experience in a variety of hospital and/or community settings.
• Experience with individuals with developmental disabilities and quality assurance is preferred.
• Experience in multicultural settings and/or multilingual capacity is preferred.

Competencies

• Strong organizational skills
• Time management
• Attention to detail
• Collaboration/teamwork
• Customer service orientation
• Respect and cultural awareness; effective self‑management of reactions
• Initiative and follow‑through
• Adaptability
• Ability to multitask with competing priorities

General Skills

• Knowledge of principles, methods, and procedures of current nursing health practices, epidemiology, developmental assessment, and intervention; ability to recognize changes in level of care.
• Ability to extract and analyze pertinent information from internal and external medical records and case notes.
• Ability to interpret and apply federal, state, and county eligibility regulations and agency procedures.
• Clear and concise communication of complex information verbally and in writing.
• Operation of basic office equipment including scanners, copiers, faxes, phones.
• Familiarity with MS Word, MS Excel, MS PowerPoint, MS Outlook or similar software.
• Organizational skills; attention to detail; initiative and follow‑up.
• Ability to identify and assist in resolving operational difficulties.
• Build partnerships and trust through collaboration, active listening, and openness to new ideas.
• Decisive action in a crisis situation.
• Responsive adaptation to multiple competing priorities.
• Use knowledge and expertise to focus on key job outcomes.
• Demonstrate respect and cultural awareness.
• Experience in multicultural settings and/or multilingual capacity.

Benefits to Working with GGRC

Comprehensive benefits package including Medical, Dental, Life, Disability, and Vision coverage with generous employer contributions.

10% employer contribution to a 403(b) retirement account.

Generous time‑off benefits: 13 vacation days, 15 sick days, 11 paid holidays, 6 personal holidays, and up to 5 paid days for continuing education.

Golden Gate Regional Center is an Equal Opportunity Employer.