Medicaid Waiver Nurse: Eligibility & Training Lead

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

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