Job Title
Case Manager – Medicaid / HCB Waiver Services
Organization
Golden Years ADHC
Base Location: 903 W Stockton Street, Edmonton, KY 42129
Phone: 270-432-2044
About Golden Years ADHC
Golden Years ADHC is an adult day health care program serving participants under Kentucky Medicaid and the Home and Community Based (HCB) Waiver. Services are designed to support adults who meet a nursing facility level of care by providing structured health monitoring, social engagement, and community-based supports. The team stands firmly on the Golden Rule—treating others as we wish to be treated—and lives this out through respect, kindness, empathy, and enriching the communities served with care.
Position Summary
The Case Manager coordinates, monitors, and advocates for services that enable waiver participants to remain safely in their homes and communities rather than institutional settings. This role leads person-centered planning, ensures services align with assessed needs and authorized limits, and maintains compliance with Kentucky Medicaid and HCB Waiver regulations, including conflict-free case management requirements. The Case Manager works closely with participants, families, providers, and the Golden Years team to promote dignity, choice, and quality of life.
About This Specific Position
This is a mix of office, home visits, and community coordination. You will manage a defined caseload, complete assessments, and develop service plans—but you will also be out in participants’ homes and lives, listening to their goals and helping make them real. The role demands attention to detail on documentation and timelines, but it is equally about building trust and advocating effectively. We would love for this individual to be a certified RN or LPN, as nursing knowledge strengthens clinical assessment, health monitoring, and coordination with medical providers—though qualified social workers or human services professionals with waiver experience are also encouraged to apply. You will receive “hip-to-hip” support to learn Golden Years’ processes, regular coaching, and clear KPIs so you know exactly what success looks like.
Key Responsibilities – Participant Support & Service Coordination
• Lead person-centered service planning in accordance with Kentucky Medicaid and HCB Waiver requirements, ensuring conflict-free case management.
• Complete initial and ongoing assessments, gather relevant history, and collaborate with participants, families, and natural supports to identify strengths, needs, and goals.
• Develop, update, and monitor individualized service plans (ISPs) that reflect assessed needs, authorized services, and risk/safety considerations per regulatory timelines.
• Coordinate services across Golden Years programs and external providers (attendant care, transportation, therapies, community resources) within authorized hours and scopes.
• Conduct regular home and community visits to monitor health, safety, satisfaction, and progress toward goals, documenting findings accurately and timely.
• Advocate for participant preferences and rights, facilitating informed choices and access to services that support community living.
• Respond promptly to changes in condition or needs, facilitating ISP updates and additional supports as appropriate.
Key Responsibilities – Compliance, Documentation & Communication
• Maintain up-to-date knowledge of Kentucky Medicaid/HCB Waiver policies, service definitions, documentation standards, and prior authorization processes.
• Complete all required assessments, ISPs, reviews, and progress notes within mandated timeframes and internal deadlines.
• Document contacts, visits, coordination, and critical incidents in designated systems for audit and quality purposes.
• Review service utilization for each participant, identifying under- or over-utilization and coordinating corrections with providers and leadership.
• Initiate, document, and track incident reports, ensuring follow-up and reporting complies with policy and regulations.
• Participate in quality improvement, audits, and corrective actions related to case management and waiver services.
• Communicate professionally and timely with participants, families, providers, and internal team members.
Schedule & Work Environment
• Full-time position with a standard weekday schedule and some flexibility for participant visits and meetings.
• Combination of office-based work (documentation, calls, virtual meetings) and field work (home/community visits).
• Local travel within the service area is required; reliable transportation is essential.
Compensation, Training & Performance Structure
• Pay band: (Negotiable) per hour, based on experience, credentials (RN/LPN preferred), and caseload capabilities.
• Training: Structured “hip-to-hip” onboarding, including shadowing, guided documentation, and waiver-specific guidance with weekly feedback.
• Performance reviews: Formal 6‑month review followed by an annual review on anniversary date, based on clear KPIs explained during orientation and handoff for transparency.
• Probationary period: 90 days to evaluate reliability, cultural fit, documentation quality, and regulatory compliance.
• Ongoing development: Monthly 1:1 check-ins, coaching, and education on person-centered planning, waiver updates, and quality care.
Qualifications & Skills
• Bachelor’s degree in social work, nursing, human services, or related field preferred; certified RN or LPN strongly preferred for clinical insight into assessments and health coordination.
• Experience in case management, care coordination, or waiver services; Kentucky Medicaid/HCB experience is a strong plus.
• Knowledge of person-centered planning, conflict-free case management, and Kentucky HCB Waiver requirements (907 KAR 7:010).
• Strong assessment, planning, and problem-solving skills balancing participant choice, safety, and regulations.
• Excellent written/verbal communication for documentation and stakeholder interactions.
• Organized time management for caseloads, deadlines, and accurate records.
• Comfort with electronic systems for documentation and coordination.
• Valid driver’s license and reliable transportation for field visits.
Disqualifiers & Pre‑Employment Requirements
• Must successfully complete required pre-employment screening:
o Criminal background check
o Drug screen
o TB test
• Valid driver’s license and current proof of auto insurance if driving is required.
• Candidates unable to meet these requirements are not eligible.
• Formal offers require acceptance and onboarding completion within 48 hours.
Cultural Expectations
• Live out the Golden Rule with participants, families, and teammates.
• Demonstrate respect, kindness, and empathy consistently.
• Enrich communities by supporting safe, choice-driven services.
How to Apply
Submit resume and brief cover letter describing:
• Case management or waiver experience.
• Clinical background (RN/LPN preferred).
• How you embody the Golden Rule and core values.
Call 270-432-2044 to speak with Golden Years Team Care leadership (Mckenzie and or Sarah) about openings.