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

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.

Education/Experience

• Bachelor’s Degree from an accredited school in Nursing. Master’s Degree preferred.
• Valid Registered Nurse License at time of hire and ability to maintain license in good standing.
• 2+ years in a variety of hospital and/or community settings
• Experience with individuals with developmental disabilities and determining quality assurance is preferred.
• Experience in multi-cultural settings and/or multi-lingual capacity is preferred.

Competencies

• Strong organizational skills

• Time management
• Attention to detail
• Collaboration/teamwork
• Customer service orientation;
• Demonstrate respect and cultural awareness; effectively manage own reactions
• Initiative and follow through
• Adaptability
• Ability to multi-task with competing priorities

General Skills

• Knowledge of principles, methods and procedures of current nursing health practices, epidemiology, methods of developmental assessment and intervention and the ability to recognize changes in level of care.
• Ability to extract and analyze pertinent information from a variety of sources including internal and external medical records and case notes.
• Ability to interpret and apply federal, state and county eligibility regulations and agency procedures.
• Ability to communicate complex information and ideas in a clear, concise and professional manner verbally and in writing.
• Ability to operate basic office equipment, including scanners, copiers, faxes, phones.
• Basic familiarity with MS Word, MS Excel, MS PowerPoint, MS Outlook or similar software applications.
• Organizational skills; attention to detail, initiative and follow-up.
• Ability to identify and assist in the resolution of operational difficulties.
• Build partnerships and trust through collaboration, active listening and an openness to new ideas.
• Act quickly and decisively in a crisis.
• Understand and effectively react/adapt to multiple and competing priorities on the job.
• Use knowledge and expertise to focus on key job outcomes
• Demonstrate respect and cultural awareness
• Experience in multi-cultural settings and/or multi-lingual capacity

What are the benefits to working with GGRC?
We offer a comprehensive benefits package including Medical and Dental benefits with a generous employer contribution and additional employer paid Life, Disability and Vision coverage

10% employer contribution to a 403(b) retirement account to help you save for the future!

GENEROUS TIME OFF BENEFITS!!!

No really, we mean generous:

13 vacation days, 15 sick days, 11 paid holidays, 6 personal holidays, and up to 5 paid days for continuing education

What makes GGRC so special?

GGRC values diversity, we believe in creating an environment where people of all backgrounds can collaborate to find solutions to complex problems. We are community minded and passionate.

GGRC values each person as a full, robust, and unique individual and interacts with each person in a manner that is respectful and responsive. We endeavor to place each person at the center of his, her or their own life. We approach each person as an expert on his, her or their own life and identity with a clear and attentive inquiry into what is important to, as well as important for, that one person (whether coworker or person-served, family member or other stakeholder).

How to apply:

GGRC values diversity; people of all backgrounds are encouraged to apply. Please complete the application and submit your most recent resume. If you feel that the questions do not accurately capture what you have to offer Golden Gate Regional Center, you are also welcome to attach a cover letter. Applications are being reviewed on a rolling basis so we encourage you to submit yours soon. We look forward to reading your application.

Golden Gate Regional Center is an Equal Opportunity Employer.