Adult Medicaid Long Term Care - Eligibility Caseworker III - Tiered Sign-on Bonus Up To $5,000
About The Position
We are seeking an Eligibility Caseworker III specializing in Adult Medicaid Long Term Care and Special Assistance programs. In this role, you'll manage ongoing eligibility determinations, process applications, and ensure accurate case documentation while supporting individuals transitioning to long-term care settings such as skilled nursing, assisted living, or memory care facilities. As part of the Adult Medicaid (AMA) team, you’ll work onsite at WakeMed’s Main Campus in Raleigh, NC, serving as a liaison between Wake County and WakeMed facilities. You will evaluate Medicaid eligibility for in-county and out-of-county patients, including those with outstanding balances, and collaborate closely with social workers, nurses, and discharge planners. This role requires navigating both NCF and EPIC systems, tracking data manually across multiple tools, and providing regular reports to WakeMed leadership.
Requirements
- Associate's degree in Human Services or a related field
- Two years of job-related experience
- Equivalent education and experience are accepted
- Ability to determine eligibility for Medicaid, Adult Medicaid, Long Term Care, Special Assistance
- Ability to identify issues, obtain relevant information, relate and compare data from different sources, and identify alternative solutions
- Knowledge and strong understanding of Adult Medicaid policy
- Ability to interpret new and changed policies
- Ability to develop and maintain strong relationships with clients by listening to the clients and understanding and responding to identified needs
- Ability to explain Medicaid policy, in layman's terms for beneficiaries, family members, and facility representatives can understand
- Excellent organizational skills and ability to maximize the use of time so that the many diverse tasks associated with the position can be completed in a timely manner
- Ability to accomplish tasks and processes accurately and completely
Nice To Haves
- Two years of experience determining eligibility in Adult Medicaid, Long Term Care, Special Assistance
- NCFast knowledge
Responsibilities
- Determine eligibility for Medicaid LTC and Special Assistance programs
- Accurately enter data and authorize benefits in agency systems
- Evaluate referrals and coordinate with WakeMed for discharges into care facilities
- Maintain thorough knowledge of policy changes and training requirements
- Manage documentation using document management systems
- Track and report data across non-integrated systems (NCF and EPIC)
- Provide support to other case managers as needed
- Attend all mandatory trainings required by both Wake County and WakeMed
Benefits
- Tiered Sign-on Bonus Up To $5,000
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
