CAP Case Manager/ Pt / Onslow & Craven Counties / Flexible Schedule

RHA Health Services • Jacksonville, NC

4d • Hybrid

About The Position

The CAP Case Manager provides critical case management services to beneficiaries who are at risk of institutionalization, ensuring their health, safety, and well-being are maintained through person-centered care planning and coordination of essential services. The Case Manager works closely with families, RNs, and other interdisciplinary team members to assess needs, coordinate care, and provide ongoing support to help beneficiaries achieve the very best possible quality of life. Home Visits & Travel are required. Applicants must live within 1 hour radius of the county. Out of area applicants will not be considered.

Requirements

• Strong understanding of Medicaid programs and compliance requirements.
• Excellent communication and interpersonal skills to work effectively with families and multidisciplinary teams.
• Ability to manage multiple priorities and maintain detailed records.
• Experience working with medically fragile children or in pediatric healthcare settings and physically disabled adults with complex care needs.
• Bachelor’s degree in social work from an accredited school of social work. Minimum of one year of directly related community experience, preferably case management, in the health or medical field (homecare, long-term care, or personal care).
• Bachelor’s degree in a human services or equivalent field from an accredited college or university. Minimum of two years of community experience, preferably case management, in the health or medical field (homecare, long-term care, or personal care).
• Bachelor’s degree in a non-human services field with two or more years of related community experience, preferably case management, in the health or medical field (homecare, long-term care, or personal care).
• Current North Carolina Registered Nurse (RN) license with a two-year or four-year degree. At least one year of case management experience in homecare, long-term care, or personal care.
• Completion of an NC Medicaid-certified training program within 90 calendar days of employment.
• Complete criminal background check.
• Name checked in the registries (OIG exclusions database, Child Abuse Registry, and Offenders Against Individuals with Developmental Disabilities).
• Drug testing.
• Education verification and other credentialing based on position requirements.
• Proof of employment history or references (if required).
• Proof of driver's license, driver's insurance, and vehicle, IF required for providing transportation for individuals.

Nice To Haves

• Applicants must live within 1 hour radius of the county. Out of area applicants will not be considered.

Responsibilities

• Conduct initial pre-screening and assessments of beneficiaries and their families to evaluate medical, psychological, behavioral, financial, social, cultural, environmental, legal, vocational, educational, and other areas.
• Consult with the CAP beneficiary and primary caregiver to educate about waiver services, other Medicaid, and community resources to meet the beneficiaries' needs.
• Identify needs to prevent health and safety factors to assist in maintaining community placement.
• Develop and maintain individualized, person-centered care plans (emergency and disaster planning) to ensure the health, safety, and well-being of beneficiaries.
• Review and update care plans at least every 12 months or when the status of the beneficiary changes.
• Assist beneficiaries and families in understanding the plan of care and making informed choices.
• Link beneficiaries and their families to necessary services, equipment, and supplies to support care in the home.
• Collaborate with community resources, healthcare providers, and other agencies to ensure comprehensive care delivery.
• Initiate appropriate referrals and utilize community resources for planning and service coordination.
• Provide ongoing monitoring of services through monthly phone calls and home visits, documenting observations, and beneficiary progress.
• Evaluate the effectiveness of care plans and services, recommending or implementing changes as needed to achieve desired outcomes.
• Maintain accurate, up-to-date case management documentation within the system, ensuring compliance with state and agency guidelines.
• Provide emotional support and basic counseling to beneficiaries and their families to strengthen their support systems.
• Assist families in navigating challenges, including long-term palliative care, behavioral issues, and medical needs.
• Assist in obtaining documentation from medical staff to confirm the need for specific CAP services.
• Maintain medical records for each beneficiary, ensuring documentation of current status, service changes, and referrals.
• Ensure compliance with 10A NCAC 27G.0202 and other regulatory guidelines.
• Complete all required records per agency policy and the State CAP manual, including discharge summaries when CAP services are completed.
• Review and ensure proper billing codes and compliance for case management, in-home aide documentation, paid live-in caregiver, re-certifications, and supply billing.
• Participate in NC Medicaid-certified training programs and ensure program compliance within 90 days of employment.
• Work closely with RNs and interdisciplinary team members to ensure a comprehensive approach to beneficiary care.
• Participate in case discussions and provide input to ensure quality care and service delivery.
• Advocate for program participants and their families to secure necessary resources and services.
• Serve as a liaison between beneficiaries, families, and external providers to address care needs effectively.
• Provide training and support to families to empower them in managing their child’s care.
• Complete all state-mandated training and agency-required continuing education annually.
• Stay current on CAP guidelines, best practices, and new developments to enhance service delivery.
• Ensure timely updates to the CAP Business system and other documentation systems as required.
• All other duties as assigned.

Benefits

• Payactiv: early access to the money you’ve earned from hours you’ve already worked, before payday!
• Employee perks and discount program : to help you save money!
• Paid Time Off (full-time employees only)
• Health/Insurance (full-time employees only)
• 401(k) retirement savings program
• Wellbeing Programs: Physical, Emotional and Financial
• Chronic Disease management programs for hypertension and diabetes (for qualifying employees)
• Training: Free CPR, first aid, and job-specific training opportunities

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level