CAP Nurse Case Manager (RN) / PT / Onslow & Duplin Area / Flexible Hours

RHA Health Services, LLC • Raleigh, NC

1d • Hybrid

About The Position

The CAP Nurse Manager works collaboratively with the CAP Social Worker, families, healthcare providers, and service providers ensuring the health, safety, and well-being of program participants. This position is responsible for conducting assessments, completing the annual multidisciplinary and Change of Status assessments, coordinating care, monitoring service delivery, and supporting the development of person-centered care plans. The RN ensures delivery of high-quality, individualized care in compliance with Medicaid guidelines and works closely with a multidisciplinary team to ensure high-quality care for participants.

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.
• Current North Carolina Registered Nurse (RN) license with a two-year or four-year degree.
• One year of case management experience in home care, long-term care, personal care, or related work.
• Completion of an NC Medicaid-certified training program within 90 calendar days of employment.

Nice To Haves

• An individual with a bachelor’s degree or who holds a nursing license as described above, without the number of years of experience, may be designated as an apprentice and shall be hired to act in the role of case manager. The supervisor of the case management shall provide direct supervision and approve all CAP/C workflow documentation and tasks.

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, 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.
• Update care plans at least every 12 months or when the status of the beneficiary changes.
• Ensure beneficiaries and families understand the plan of care to make informed decisions.
• Coordinate services such as personal care, waiver supplies, home modifications, and educational support in alignment with the care plan.
• Collaborate with the team to monitor service quality and ensure compliance with Medicaid and program standards.
• Arrange for additional services as needed to prevent institutionalization and support participants in their homes.
• Monitor services through monthly phone calls and home visits, document observations and beneficiary progress.
• Evaluate the effectiveness of care plans and services, recommending or implementing changes as needed to achieve desired outcomes.
• Provide emotional support and 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 with obtaining documentation from medical staff to confirm the need for specific CAP services.
• Maintain accurate and up-to-date records for all participants in accordance with Medicaid and program requirements.
• Ensure compliance with 10A NCAC 27G.0202 and other regulatory guidelines.
• 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.
• Ensure timely updates to the CAP Business system and other documentation systems as required.
• Work closely with SWs and interdisciplinary team members to ensure a comprehensive approach to beneficiary care.
• Act as an advocate for program participants and their families to secure necessary resources and services.
• Work closely with service providers, community agencies, and healthcare professionals to optimize care outcomes.
• 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.
• 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: Part-time
• Career Level: Mid Level
• Education Level: Associate degree