ADvantage Case Manager

Job Summary

The Advantage Case Manager is responsible for managing the care, coordination, and oversight of clients

enrolled in Oklahoma’s ADvantage Medicaid Waiver Program. The Case Manager ensures that participants

receive timely, appropriate, and high-quality services designed to maintain independence and prevent

unnecessary institutionalization. This position collaborates with clinical, operational, and community partners

to ensure regulatory compliance, fiscal responsibility, an

Licensed Practical Nurse (LPN) with an active Oklahoma license as verified on the Oklahoma Board of

Nursing website**, with one (1) year of paid professional or technical experience* providing direct care services

• Paid technical experience may include, but is not limited to: Certified Nursing Assistant (CNA),

Certified Medical Assistant (CMA), Certified Home Health Aide (CHHA), or Personal Care Assistant

(PCA) experience.

Experience:

 Minimum of one (1) year of direct care experience as defined above.

 At least 3–5 years of experience in case management, home and community-based

services, or long-term care coordination preferred.

 Experience with Medicaid waiver programs, home health, or long-term care services

strongly preferred.

Skills:

• In-depth knowledge of Oklahoma ADvantage Program and its guidelines
• Excellent communication, organizational, and problem solving skills
• Ability to work independently and manage a caseload effectively
• Strong computer skills and ability to navigave case management software

Transportation: Reliable transportation and valid and current auto liability insurance.

 Conduct comprehensive assessments and ongoing reassessments of participants’ care

needs and eligibility.

 Develop, implement, and manage individualized service plans consistent with ADvantage

waiver requirements.

 Monitor and coordinate delivery of waiver services (e.g., therapy, home health, PT/OT/SLP,

personal care, environmental modifications, respite, medical supplies).

 Perform clinical oversight and review, or adjusting services to maintain quality and prevent

overutilization.

 Manage interdisciplinary collaboration with formal and informal support system.

 Ensure compliance with ADvantage waiver rules, documentation requirements, service

authorization, and regulatory reporting.

 Monitor metrics such as participant outcomes, service utilization, hospital / nursing home

transitions, and participant satisfaction.

 Provide participant and family education regarding program services, rights, and

responsibilities.

 Serve as liaison with Oklahoma Department of Human Services / Aging Division, OHCA,

and relevant regulatory entities.

 Participate in internal audits, quality improvement initiatives, and corrective action plans as

needed.

Key Performance Indicators (KPIs)

 Compliance audit accuracy / error rates

 Timely development and completion of service plans

 Participant satisfaction / complaint rates

 Clean claim / documentation acceptance rates

 Service utilization relative to budget / cost controls

Core Competencies

 Medicaid waiver program knowledge (ADvantage)

 Case management and care coordination

 Regulatory compliance and documentation accuracy

 Outcome-driven decision-making

 Communication and stakeholder relations

 Interdisciplinary collaboration

 Problem-solving and resource management