Insurance Risk Manager Jobs in Edmonton, KY (NOW HIRING)

Organization: Golden Years ADHC

Base Location: 777 Industrial Drive, Edmonton, KY 42129

Phone: 270-432-2044

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.

The LPN/RN provides services at our day center as a temporary status 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. The LPN/RN works closely with participants, families, providers, and the Golden Years team to promote dignity, choice, and quality of life.

The role demands attention to detail on documentation and timelines, but it is equally about building trust and advocating effectively. As a Temporary LPN/RN the 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 personcentered service planning in accordance with Kentucky Medicaid and HCB Waiver requirements, ensuring conflictfree 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, and risk/safety considerations per regulatory timelines for our daycare participants.
• 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 uptodate 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.
• Initiate, document, and track incident reports, ensuring followup and reporting complies with policy and regulations.
• Communicate professionally and timely with participants, families, providers, and internal team members.
Schedule & Work Environment
• LPN/RN position with a standard weekday schedule.
Must successfully complete required pre-employment screening:
• Criminal background check o Drug screen
• 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, choicedriven services.