MEDICAL CERTIFICATION SPECIALIST 1 or 2
About The Position
CAHS excels at making lives better by delivering caring and responsive services, leading to a better tomorrow. CAHS commits to the philosophy that all individuals are valuable members of the community and exist to help each person(s) served live productively in the location and environment of their choosing and abilities. CAHS staff works as a unified team to provide services and supports that help person(s) served succeed in work, school, life, and other endeavors they pursue. We are seeking a dedicated and detail-oriented Medical Certification Specialist to join our certification team and ensure the accurate, timely, and compliant delivery of Waiver Services. This rewarding role offers the opportunity to make a meaningful difference in the lives of individuals with developmental disabilities and their families throughout our district. This position offers the opportunity to build professional relationships, contribute to quality service delivery, and positively impact the well-being of the individual and communities we serve. If you are passionate about public service, enjoy working with diverse populations, and are dedicated to ensuring compliance while providing compassionate support, we encourage you to apply and become a valued member of our team.
Requirements
- A current Louisiana license in a health services field, health regulation field, or social services field plus two years of experience in hospital or nursing home administration, health services, health regulation, or social services
- A bachelor's degree plus two years of experience in hospital or nursing home administration, health services, health regulation, or social services
- A master's degree in a health services field, health regulation field, or a social services field plus one year of experience in hospital or nursing home administration, health services, health regulation, or social services
Responsibilities
- Certify applicants as medically eligible to receive Medical Waiver Services.
- Analyze and review Comprehensive Plans of Care (CPOC) with required documentation to ensure that an individual meets medical eligibility for Waiver Services, initially and annually.
- Conducts quality assurance of case management agencies and service providers relative to organization, policies and procedures, administration, qualifications of staff and quality of services to determine the extent of compliance with Medicaid regulations and waiver recipients comprehensive plan of care.
- Returns incomplete plans to Support Coordination Agency and communicates the need regarding further information and why plan is deemed incomplete.
- Provides technical assistance to Support Coordination Agencies regarding methods of improving the incomplete plan.
- Utilizes professional medical knowledge and judgement in evaluation of appropriateness and quality of medical care by assessing individual's overall health, welfare and safety, assuring that provided waiver services meet compliance.
- Conducts special investigations in response to complaints and prepares report findings.
- Compiles information derived from surveys or paid Medicaid claims data and reports findings to recommend whether licensure and/or certification should be granted, denied, deferred, continued, or a change in Medicaid reimbursement is warranted.
- Consult with psychologist, psychiatrist, and/or physician as needed to reach a final eligibility determination.
- Utilize professional nursing knowledge and judgment in assessing the delegation of medical tasks, procedures, and treatments to non-licensed staff.
- Receives, reviews, and determines appropriateness of recipient appeals of denied services.
- Gathers factual information and prepares summary of evidence.
- Presents testimony before Administrative Law Judge.
- Completes/processes appropriate paperwork for waiver participants transferring into and out of other regions; and paperwork for discharges/closures/inactive status.
- Act as Liaison to non-waiver participants and other agency/entities.
- Creates and monitors a continuous quality improvement process.
- Uses a variety of computer programs and web based systems that are specific to the waiver service delivery system.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
