CAP Case Manager / PT / Buncombe-Madison Area / Flexible Hours

RHA Health Services • Asheville, NC

19h

About The Position

The CAP Case Manager provides case management to beneficiaries at risk of institutionalization, helping maintain their health, safety, and well-being through person-centered planning and coordination of services. The role works with beneficiaries, families, registered nurses, and interdisciplinary teams to assess needs, coordinate care, and provide ongoing support that promotes quality of life and community placement.

The Case Manager assesses beneficiaries and their families; explains waiver, Medicaid, and community resources; develops and updates individualized care plans; links beneficiaries to services, equipment, and supplies; and monitors progress through phone calls and home visits. The position also provides basic counseling and family support, maintains accurate records, coordinates referrals, advocates for beneficiaries, and ensures compliance with state, agency, and CAP program requirements. Required training and continuing education must be completed, including an NC Medicaid-certified training program within 90 calendar days of employment.

Requirements

• Strong understanding of Medicaid programs and compliance requirements.
• Excellent communication and interpersonal skills for working 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 with physically disabled adults who have complex care needs.
• Meet one of the following education and experience pathways: a bachelor's degree in social work and at least one year of directly related community experience; a bachelor's degree in human services or an equivalent field and at least two years of related community experience; a bachelor's degree in a non-human-services field and at least two years of related community experience; or a current North Carolina RN license with a two- or four-year degree and at least one year of case management experience.
• Related experience is preferably in case management in a health or medical field such as homecare, long-term care, or personal care.
• Complete an NC Medicaid-certified training program within 90 calendar days of employment.
• An individual with a qualifying bachelor's degree or nursing license who does not yet have the required experience may be designated as an apprentice; the supervisor must directly supervise the apprentice and approve CAP/C workflow documentation and tasks.
• Able to lift at least 10 pounds and pull at least 20 pounds.
• Able to squat, kneel, crawl, crouch, climb, and stoop; regularly stand and walk.

Responsibilities

• Conduct pre-screenings and assessments of beneficiaries and families across medical, psychological, behavioral, financial, social, cultural, environmental, legal, vocational, educational, and other areas.
• Educate beneficiaries and primary caregivers about waiver services, Medicaid, and community resources.
• Identify needs and risks that may affect health, safety, or continued community placement.
• Develop and maintain individualized, person-centered care plans, including emergency and disaster planning, and review them at least every 12 months or when beneficiary status changes.
• Help beneficiaries and families understand care plans and make informed choices.
• Link beneficiaries and families to services, equipment, and supplies needed to support care at home.
• Collaborate with community resources, healthcare providers, and other agencies; initiate referrals and coordinate services.
• Monitor services through monthly phone calls and home visits, document observations and progress, and evaluate care-plan effectiveness.
• Recommend or implement changes to care plans and services to achieve desired outcomes.
• Maintain accurate, current case management documentation in accordance with state and agency guidelines.
• Provide emotional support and basic counseling to beneficiaries and families, including support with palliative care, behavioral issues, and medical needs.
• Obtain medical documentation confirming the need for specific CAP services and maintain beneficiary medical records documenting status, service changes, and referrals.
• Comply with 10A NCAC 27G.0202, agency policy, the State CAP manual, and applicable billing and documentation requirements; complete discharge summaries when services end.
• Review billing codes and documentation for case management, in-home aide services, paid live-in caregivers, recertifications, and supplies.
• Complete an NC Medicaid-certified training program within 90 calendar days of employment and maintain program compliance.
• Work with RNs and interdisciplinary team members, participate in case discussions, and contribute to quality care and service delivery.
• Advocate for participants and families, serve as a liaison with external providers, and help secure needed resources and services.
• Train and support families in managing their child's care.
• Complete state-mandated training and agency-required continuing education annually; stay current on CAP guidance and update required documentation systems.
• Perform other duties as assigned.

Benefits

• Payactiv early access to earned wages before payday.
• Employee perks and discount program.
• Paid time off for full-time employees only.
• Health and insurance benefits for full-time employees only.
• 401(k) retirement savings program.
• Wellbeing programs covering physical, emotional, and financial well-being.
• Chronic disease management programs for hypertension and diabetes for qualifying employees.
• Free CPR, first aid, and job-specific training opportunities.

What This Job Offers

• Job Type: Part-time