CASE MANAGEMENT SERVICES PROVIDER IN NEW JERSEY

Fatumata Kaba
Sep 5
4 min read

COORDINATING CARE AND SUPPORT THROUGH INDIVIDUALIZED CASE MANAGEMENT

Case Management Services in New Jersey support individuals with disabilities, chronic conditions, or long-term care needs by coordinating services, developing care plans, and facilitating access to resources. These services ensure that individuals receive comprehensive, person-centered care. Case Management Services are authorized under New Jersey Medicaid Home and Community-Based Services (HCBS) Waiver programs.

1. GOVERNING AGENCIES

Agency: New Jersey Department of Human Services (DHS)

Role: Administers Medicaid waiver funding for Case Management Services and manages provider enrollment, service authorization, and reimbursement.

Agency: Division of Developmental Disabilities (DDD)

Role: Ensures quality standards, service delivery, and compliance for Case Management Services under HCBS waiver programs.

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight ensuring Medicaid-funded Case Management Services meet HCBS quality, person-centered planning, and participant protection standards.

2. CASE MANAGEMENT SERVICES OVERVIEW

Case Management Services coordinate and manage care to enhance an individual’s ability to live independently and safely within the community.

Approved providers may deliver:

Needs Assessment: Conducting comprehensive evaluations to identify care requirements.
Service Planning: Developing an Individualized Service Plan (ISP) tailored to each participant.
Care Coordination: Arranging healthcare, social, and community services.
Monitoring and Follow-Up: Regularly reviewing progress and updating care plans as needed.
Crisis Intervention: Providing support during emergencies and coordinating responses.
Resource Navigation: Assisting individuals in accessing community resources and financial support.
Advocacy: Supporting participants in obtaining necessary services and advocating for their rights.

All services are delivered according to the ISP to meet the unique needs and preferences of the participant.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register the business entity with the New Jersey Division of Revenue and Enterprise Services.
Obtain EIN from the IRS and NPI (Type 2).
Enroll as a Medicaid Waiver Case Management provider via the New Jersey Medicaid Provider Enrollment Portal.
Obtain any necessary licensure for case management services from DHS if applicable.
Maintain general liability and professional liability insurance.
Develop policies for care coordination, crisis response, and documentation.
Ensure staff meet background checks, health screenings, and case management training requirements.

4. NEW JERSEY PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

Complete the Provider Enrollment Application through the New Jersey Medicaid Provider Enrollment Portal for Case Management Services under HCBS waivers.

Application and Documentation Submission:

Submit Articles of Incorporation, proof of EIN/NPI, insurance certificates, staff qualifications, and policy manuals.

Program Readiness Review:

DHS and DDD evaluate provider readiness, including staff qualifications, service planning protocols, and safety measures.

Approval & Medicaid Enrollment:

Upon approval, providers are authorized to bill Medicaid for Case Management Services using designated billing codes.

5. REQUIRED DOCUMENTATION

Articles of Incorporation or Business License (New Jersey Division of Revenue)
IRS EIN confirmation
NPI confirmation
Proof of general and professional liability insurance
Case Management Services Policy & Procedure Manual including:
- Participant intake, needs assessment, and care planning procedures
- Coordination of healthcare, social, and community-based services
- Crisis intervention and emergency response protocols
- Staff credentialing, background checks, and ongoing training records
- HIPAA compliance, participant rights, and grievance handling
- Documentation standards for service coordination and Medicaid billing
- Quality assurance and compliance monitoring

6. STAFFING REQUIREMENTS

Role: Case Management Program Director

Requirements: Bachelor’s or Master’s degree in social work, human services, or healthcare; certification in case management preferred; supervisory experience.

Role: Case Managers

Requirements: Bachelor’s degree in social work, healthcare, or a related field; experience in care coordination and service planning; background clearance.

Role: Case Management Assistants

Requirements: High school diploma or GED; experience in administrative support and data entry; background clearance.

All staff must complete: