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

RHA Health Services, LLC • Asheville, NC

2d

About The Position

The CAP Case Manager provides case management to beneficiaries at risk of institutionalization, supporting their health, safety, and well-being through person-centered care planning and coordination of essential services. The role works with beneficiaries, families, registered nurses, and interdisciplinary team members to assess needs, coordinate care, and provide ongoing support to improve quality of life.

The Case Manager conducts assessments, educates beneficiaries and caregivers about waiver services and community resources, identifies needs that affect safe community placement, and develops and updates individualized care plans. The role links beneficiaries to services, equipment, and supplies; coordinates with providers and agencies; and monitors services through monthly phone calls and home visits. It also provides emotional support and basic counseling, advocates for beneficiaries and families, and maintains accurate records in accordance with state, agency, and CAP requirements.

The position has no supervisory responsibilities. Candidates must meet one of the education and experience pathways listed in the posting, and complete an NC Medicaid-certified training program within 90 calendar days of employment. The work includes physical demands such as lifting at least 10 pounds, pulling at least 20 pounds, squatting, kneeling, crawling, crouching, climbing, stooping, and regularly standing and walking.

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 with complex care needs.
• Meet one of the following education and experience pathways:
• Social work pathway: bachelor's degree in social work from an accredited school of social work and at least one year of directly related community experience, preferably case management in health or medical settings such as homecare, long-term care, or personal care.
• Human services pathway: bachelor's degree in a human services or equivalent field from an accredited college or university and at least two years of community experience, preferably case management in a health or medical setting.
• Non-human services pathway: bachelor's degree in a non-human services field and at least two years of related community experience, preferably case management in a health or medical setting.
• Nursing pathway: current North Carolina Registered Nurse license with a two-year or four-year degree and at least one year of case management experience in homecare, long-term care, or personal care.
• Complete an NC Medicaid-certified training program within 90 calendar days of employment.
• 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.
• Complete pre-employment criminal background screening, registry checks, drug testing, education verification, and any credentialing required for the position.
• For positions requiring driving, provide proof of driver's license, driver's insurance, and a vehicle if required to transport individuals.

Nice To Haves

• Community experience in case management in homecare, long-term care, or personal care is preferred in the education and experience pathways.
• A degree or nursing license without the listed years of experience may qualify an individual for apprentice designation; the supervisor provides direct supervision and approves CAP/C workflow documentation and tasks.

Responsibilities

• Conduct initial pre-screening and assessments of beneficiaries and their families across medical, psychological, behavioral, financial, social, cultural, environmental, legal, vocational, educational, and other areas.
• Educate beneficiaries and primary caregivers about waiver services, other Medicaid options, and community resources.
• Identify needs and risks affecting health, safety, and the ability to maintain community placement.
• Develop and maintain individualized, person-centered care plans, including emergency and disaster plans, and review them at least every 12 months or when a beneficiary's status changes.
• Help beneficiaries and families understand care plans and make informed choices.
• Connect beneficiaries and families with services, equipment, and supplies needed to support care at home.
• Coordinate with community resources, healthcare providers, agencies, registered nurses, and interdisciplinary team members.
• Initiate referrals and use community resources for planning and service coordination.
• Monitor services through monthly phone calls and home visits; document observations and beneficiary progress.
• Evaluate care plan and service effectiveness and recommend or implement changes to achieve desired outcomes.
• Maintain accurate and current case management documentation and medical records in accordance with state and agency requirements.
• Provide emotional support and basic counseling to beneficiaries and families, including support with palliative care, behavioral issues, and medical needs.
• Obtain documentation from medical staff supporting the need for specific CAP services.
• Ensure compliance with 10A NCAC 27G.0202 and other applicable regulatory guidelines; complete required records, including discharge summaries.
• Review billing codes and documentation for case management, in-home aide services, paid live-in caregivers, recertifications, and supply billing.
• Complete NC Medicaid-certified training within 90 days of employment and required state training and annual continuing education.
• Keep CAP Business and other documentation systems updated as required.
• Participate in case discussions, provide input on care and service delivery, advocate for participants and families, and serve as a liaison with external providers.
• Train and support families in managing their child's care.
• 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 insurance for full-time employees only.
• 401(k) retirement savings program.
• Physical, emotional, and financial wellbeing programs.
• 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
• Career Level: Entry Level