Eligibility Hearing Officer

DHRM • Richmond, VA

21h • Hybrid

About The Position

The Eligibility Hearing Officer works in the Appeals Division of the Virginia Department of Medical Assistance Services (DMAS). The role reviews appeal requests, case documents, and other evidence; conducts client eligibility appeal hearings; and renders written appeal decisions at the highest administrative level in accordance with fair-hearing principles and established timeframes. The officer applies laws, rules, regulations, administrative procedures, due-process standards, and legal research methods to independently reach decisions based on findings of fact and conclusions of law. The position also requires independent caseload management, timely compliance with deadlines, and thorough, accurate, objective analysis of facts, evidence, and law to produce legally sound and defensible decisions.

The officer is expected to provide respectful, dignified customer service, ensure appellants receive full due process, support a collaborative and positive work environment, and produce quality work. Business needs require some in-office work, including in-person hearings. Telework arrangements are governed by Commonwealth policy and may change or end based on performance or business needs.

Requirements

• Experience independently managing a caseload to meet established timeframes.
• Considerable work-related experience applying rules to facts to reach logical, legally supportable conclusions.
• Knowledge of administrative law and/or appeals procedures.
• Considerable knowledge of legal research methodologies, including computerized legal research.
• Considerable experience with technology, including MS Office.
• Considerable experience interpreting, applying, and analyzing complex federal and state laws, regulations, policies, or case law.
• Experience meeting deadlines.
• Experience working with internal and external stakeholders.
• Considerable experience in legal analysis and legal writing.

Nice To Haves

• Admission to the Virginia State Bar in good standing.
• Experience drafting appeal decisions.

Responsibilities

• Review appeal requests, case documents, and other appropriate evidence in preparation for client eligibility appeal hearings.
• Conduct client eligibility appeal hearings.
• Render written appeal decisions at the highest administrative level in accordance with fair-hearing principles and established timeframes.
• Apply laws, rules, regulations, administrative procedures, due-process standards, and legal research methods to independently render decisions based on findings of fact and conclusions of law.
• Conduct legal research and objectively analyze and evaluate facts, evidence, and law to make legally sound, defensible recommendations and judgments.
• Independently manage a caseload and meet established deadlines.
• Provide respectful and dignified customer service, ensure appellants receive full due process, support a collaborative work environment, and produce quality work.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed