Medical Certification Manager 1

State of Louisiana•Statewide, LA

5d•Hybrid

About The Position

The mission of the Louisiana Department of Health is to protect and promote health and to ensure access to medical, preventive, and rehabilitative services for all residents of the State of Louisiana. This position serves as the Regional Manager for the Office of Aging and Adult Services (OAAS) regional offices. The incumbent supervises and monitors the operations of all long term care programs that serve older adults and persons with adult onset disabilities. Incumbent must possess a thorough knowledge of state and federal Medicaid guidelines and LDH/OAAS rules, policies and procedures in addition to knowledge of the service system for all Medicaid Long Term Care Programs, including Nursing Facilities, Community Choices Waiver (CCW), Adult Day Health Care (ADHC) Waiver, Long-Term-Personal Care Services (LT-PCS), the Program for the All-Inclusive Care for the Elderly (PACE) and community resources.

Requirements

A current Louisiana license in a health services field, health regulation field, or social services field plus five years of experience as a licensed practitioner in hospital or nursing home administration, health services, health regulation, or social services; OR
A bachelor's degree plus five years of experience in hospital or nursing home administration, health services, health regulation, or social services; OR
A master's degree in a health services field, health regulation field, or a social services field plus four years of experience in hospital or nursing home administration, health services, health regulation, or social services.

Nice To Haves

Thorough knowledge of state and federal Medicaid guidelines and LDH/OAAS rules, policies and procedures.
Knowledge of the service system for all Medicaid Long Term Care Programs, including Nursing Facilities, Community Choices Waiver (CCW), Adult Day Health Care (ADHC) Waiver, Long-Term-Personal Care Services (LT-PCS), the Program for the All-Inclusive Care for the Elderly (PACE) and community resources.

Responsibilities

Administers all regional OAAS programs through direct and indirect supervision of subordinates to ensure programmatic needs are met and assignments are completed timely.
Plans, organizes and coordinates activities for regional operations.
Manages and coordinates the administrative activities of the OAAS regional office.
Oversees the assignment of monitoring reviews of all support coordination agencies and a representative sample of all participants at least annually utilizing specially developed program monitoring tools. This includes both on-site and in-home reviews, interviews and record reviews as well as ongoing review of performance data.
Reviews the monitoring results and determined remediation required and its severity for the agency and on behalf of the participant.
Oversees the State Civil Service and contract staff responsible for coordinating the day-to-day duties of the Program Operations Division.
With the OAAS Leadership Team, establishes and monitors strong recruitment and retention strategies.
Duties assigned and supervised include, but are not limited to, managing waiver participants' certification, issuing denial/discharge notices with appeal rights as appropriate, completing in field Nursing Facility Level of Care (NFLOC) determinations with individuals and participants, conducting Support Coordination Agency (SCA) monitoring (on-site and data review), providing technical assistance to Direct Service Providers (DSPs) and SCAs, conducting participant home visits and delivering training to SCAs and DSPs statewide.
Responsible for managing the reporting, review of and response to critical incidents by direct service providers and support coordinators.
Assures that all participant health and welfare follow-up has been accomplished by providers.
Nursing Facility Outreach, Connection to Services and Level of Care Determinations & Technical Assistance