CAP Case Manager / Social Worker / PT / Gaston County / Flexible Hours

About this role

We are hiring for: CAP Case Manager / Social Worker / PT / Gaston County / Flexible Hours Type: Regular If you are a positive and personable individual looking for a satisfying and fun opportunity to make a real difference in the lives of people with intellectual, developmental disabilities, and people facing mental health, and substance use challenges, join our team at RHA Health Services!  

The CAP Case Manager provides critical case management services to beneficiaries who are at risk of institutionalization, ensuring their health, safety, and well-being are maintained through person-centered care planning and coordination of essential services.

The Case Manager works closely with families, RNs, and other interdisciplinary team members to assess needs, coordinate care, and provide ongoing support to help beneficiaries achieve the best possible quality of life. DUTIES AND RESPONSIBILITIES: • Assessment and Care Planning: • 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. • Consultation with the CAP beneficiary and primary caregiver to educate about waiver services, other 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. • Review and update care plans at least every 12 months or when the status of the beneficiary changes. • Assist beneficiaries and families in understanding the plan of care and making informed choices.

• Coordination of Services: • Link beneficiaries and their families to necessary services, equipment, and supplies to support care in the home. • Collaborate with community resources, healthcare providers, and other agencies to ensure comprehensive care delivery. • Initiate appropriate referrals and utilize community resources for planning and service coordination.

• Monitoring and Follow-Up: • Provide ongoing monitoring of services through monthly phone calls and home visits, documenting observations, and beneficiary progress. • Evaluate the effectiveness of care plans and services, recommending or implementing changes as needed to achieve desired outcomes. • Maintain accurate, up-to-date case management documentation within the system, ensuring compliance with state and agency guidelines.

• Counseling and Support: • Provide emotional support and basic 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.

• Documentation and Compliance: • Assist in obtaining documentation from medical staff to confirm the need for specific CAP services. • Maintain medical records for each beneficiary, ensuring documentation of current status, service changes, and referrals. • Ensure compliance with 10A NCAC 27G.0202 and other regulatory guidelines. • Complete all required records per agency policy and the State CAP manual, including discharge summaries when CAP services are completed. • 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.

• Collaboration and Advocacy: • Work closely with RNs and interdisciplinary team members to ensure a comprehensive approach to beneficiary care. • Participate in case discussions and provide input to ensure quality care and service delivery. • Advocate for program participants and their families to secure necessary resources and services. • Serve as a liaison between beneficiaries, families, and external providers to address care needs effectively. • Provide training and support to families to empower them in managing their child’s care.

• Continuing Education and Professional Development: • 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. • Ensure timely updates to the CAP Business system and other documentation systems as required.

• All other duties as assigned.

SUPERVISORY RESPONSIBILITIES:  This position has no supervisory responsibilities.

MINIMUM QUALIFICATIONS: • 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.

Education and Experience: Candidates must meet one of the following criteria: Social Work Background: • Bachelor’s degree in social work from an accredited school of social work. • Minimum of one year of directly related community experience, preferably case management, in the health or medical field (homecare, long-term care, or personal care). • Completion of an NC Medicaid-certified training program within 90 calendar days of employment.

Human Services Background: • Bachelor’s degree in a human services or equivalent field from an accredited college or university. • Minimum of two years of community experience, preferably case management, in the health or medical field (homecare, long-term care, or personal care). • Completion of an NC Medicaid-certified training program within 90 calendar days of employment.

Non-Human Services Background: • Bachelor’s degree in a non-human services field with two or more years of related

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