Service Authorization Consultant

DHRM • Richmond, VA

4d • Hybrid

About The Position

The Department of Behavioral Health and Developmental Services (DBHDS) is seeking a highly motivated individual to ensure that the DBHDS Developmental Disabilities waivers’ service authorization system maintains all standards of accountability, proficiency and responsiveness to the users of the system which results in the alignment of needs and resources of all the individuals receiving waiver funded services. Incumbent will be responsible for the review of Individual Support Plans, Supporting Documentation, and Service Authorizations for the waivers for individuals with developmental disabilities, assuring that all criteria are met from when the process initiates with the case manager/support coordinator through to the authorization of a service. This includes, but is not limited to, discussing appropriate service alternatives with support coordinators/case managers and their supervisors to include the provision of needed training and technical assistance; problem solving to ensure individuals receive the appropriate services according to their assessed needs; and communicating the results of the review process to CSBs, private providers and the VA Medicaid Management Information System. This is a Richmond Central Office (CO) position and while there may be an opportunity for limited telework, which is currently one day per week, the expectation is that the selected candidate will be working in CO. This position may require frequent state travel. Additional responsibilities include: Performing clinical review and/or authorization of waiver and EPSDT services for individuals with developmental disabilities for all new and revised service plans, as appropriate. Utilizing knowledge of authorization procedures and interpretation of Medicaid regulations, policies, and procedures. Accurately entering service authorization information into the Waiver Management System (WaMS) & the Virginia Medicaid Enterprise System (MES). Providing service authorization related consultation and training to assigned Community Services Boards/private providers of case management services. Analyzing trends and problem areas within localities; providing recommendations and assistance to other DDS staff regarding technical support, training, and the development of guidance materials. Abiding by all legal and regulatory standards promulgated by state, federal and professional regulatory organizations and will engage in conduct that is professional and ethical at all times, to the best of my knowledge and understanding.

Requirements

• Knowledge of professional standards of supports and services for individuals with developmental disabilities (DD), including knowledge of best practices.
• Knowledge of the health care needs of persons with disabilities (physical, cognitive, emotional), health and social service programs and issues, community resources, state and federal DD regulations, negotiation techniques, problem resolution, medical terminology, and medical standards of treatment.
• Ability to work with electronic information systems.
• Demonstrated ability to organize and prioritize work assignments, and to communicate effectively orally and in writing.
• Ability to research and identify changes in program requirements and policies and to interpret state and federal regulations.
• Ability to use a range of computer programs and database applications such as Word, Excel, and the Internet.

Nice To Haves

• Bachelor’s degree in a human services field (including, but not limited to, sociology, social work, special education, rehabilitation counseling, or psychology).
• Demonstrated training/professional experience in the delivery of services to individuals with DD.
• Experience in social, behavioral science, education, or related human services field.
• Understanding of best practices in developmental disability (DD) services or understanding of how best practices are adopted and ability to translate experiences and training within the DD system.

Responsibilities

• Performing clinical review and/or authorization of waiver and EPSDT services for individuals with developmental disabilities for all new and revised service plans, as appropriate.
• Utilizing knowledge of authorization procedures and interpretation of Medicaid regulations, policies, and procedures.
• Accurately entering service authorization information into the Waiver Management System (WaMS) & the Virginia Medicaid Enterprise System (MES).
• Providing service authorization related consultation and training to assigned Community Services Boards/private providers of case management services.
• Analyzing trends and problem areas within localities; providing recommendations and assistance to other DDS staff regarding technical support, training, and the development of guidance materials.
• Abiding by all legal and regulatory standards promulgated by state, federal and professional regulatory organizations and will engage in conduct that is professional and ethical at all times, to the best of my knowledge and understanding.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level