Full-Time
Medicaid Waiver Nurse
Golden Gate Regional Center
Compensation Overview
$63k - $75.6k/yr
San Francisco, CA, USA
Hybrid
Bachelor's, Master's
Category
 Medical, Clinical & Veterinary |
|---|
Required Skills
Nursing
Word/Pages/Docs
HIPAA
Data Analysis
Excel/Numbers/Sheets
Microsoft Outlook
Requirements
- A Bachelor's Degree from an accredited school in Nursing is required.
- A valid Registered Nurse license is required at the time of hire and must be maintained in good standing.
- At least 2 years of experience in a variety of hospital and/or community settings is required.
- Knowledge of current nursing health practices, epidemiology, developmental assessment and intervention methods, and recognition of changes in level of care is required.
- Ability to extract and analyze pertinent information from internal and external medical records and case notes is required.
- Ability to interpret and apply federal, state, and county eligibility regulations and agency procedures is required.
- Ability to communicate complex information clearly, concisely, and professionally in verbal and written form is required.
- Ability to operate basic office equipment, including scanners, copiers, fax machines, and phones, is required.
- Basic familiarity with Microsoft Word, Microsoft Excel, Microsoft PowerPoint, Microsoft Outlook, or similar software applications is required.
- Ability to identify and assist in resolving operational difficulties is required.
- Ability to manage multiple competing priorities and respond decisively in a crisis is required.
- Ability to maintain confidentiality in compliance with the Health Insurance Portability and Accountability Act of 1996 and the California Lanterman Act is required.
Responsibilities
- Determine Medicaid Waiver eligibility for individuals supported by GGRC in accordance with Department of Developmental Services regulations.
- Review case records to confirm that assessed needs are supported by current documentation, collaborate with Case Managers, ensure the Client Development Evaluation Report is accurate and updated, and ensure Consumer Choice forms are received and filed in electronic records.
- Determine Medicaid Waiver eligibility for Institutional Deeming Referrals to Medi-Cal, receive and process referrals, track them, and follow up with Case Managers.
- Perform annual recertification reviews for individuals enrolled in the Medicaid Waiver program.
- Perform Medicaid Waiver terminations when eligibility requirements are no longer met.
- Distribute Medicaid Waiver documentation for data entry and filing in electronic records.
- Review and compare State and Regional Center reports to ensure data accuracy.
- Assist with Federal and State audits and follow up on corrective action plans as needed.
- Inform, educate, and provide input to case management staff and others regarding the Medicaid Waiver program, documentation, and changes in individuals' Medicaid Waiver status.
- Assist with new-hire orientation sessions and ongoing training for case management staff on the Medicaid Waiver program.
- Establish and maintain relationships with the Department of Developmental Services and County Health and Human Services offices to facilitate information exchange with community partners.
- Participate in related projects and perform additional assigned duties.
- Maintain confidential information about individuals supported in compliance with applicable privacy and state laws.
Desired Qualifications
- A Master's Degree is preferred.
- Experience with individuals with developmental disabilities and determining quality assurance is preferred.
- Experience in multicultural settings and/or multilingual capacity is preferred.