Medical Certification Specialist 2

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Medical Certification Specialist 2

Salary

$5,477.00 - $9,856.00 Monthly

Location

New Orleans, LA

Job Type

Classified

Job Number

MHSD-196828-ACZ

Department

Metropolitan Human Services District

Opening Date

07/02/2024

Closing Date

7/10/2024 11:59 PM Central

• Description

• Benefits

• Questions

Supplemental Information

MHSD-196828-ACZ

We are currently hiring for a Medical Certification Specialist 2 Developmental Disabilities Office.

Metropolitan Human Services District

719 Elysian Fields Ave, New Orleans, LA 70117

This Medical Certification position is within Metropolitan Human Services District - Developmental Disabilities Office. The incumbent performs advanced level duties involving reviews, interpretation and decisions of certification/eligibility for Medicaid expenditures for individuals seeking Home and Community Based Waiver Services (HCBWS) in accordance with federal and state Medicaid guidelines. The incumbent must be knowledgeable of policy/procedures in accordance with the separate HCBWS currently being administered in Louisiana: New Opportunities Waiver, Children's Choice Waiver, Supports Waiver and Residential Options Waiver.

The applicant must possess the following competencies:

• Communicating Effectively:The ability to relay information correctly and appropriately to connect people and ideas.

• Demonstrating Accountability:The ability to accept ownership for your actions, behaviors, performance, and decisions.

• Developing Performance:The ability to assist others in advancing their skills, knowledge, and performance levels over time.

• Displaying Expertise:The ability to exhibit specialized skills or knowledge gained from experience or training

• Focusing on Customers:The ability to serve the needs of those who support and/or rely on the services provided.

• Following Policies and Procedures:The ability to comply with policies and procedures of the organization as well as State Civil Service rules, and all applicable federal and state laws.

• Making Accurate Judgments:The ability to form an opinion objectively and decisively based on relevant information and in accordance with established standards.

• Managing Conflict:The ability to recognize and navigate disagreements in a rational, unbiased, and productive way.

• Managing Risks:The ability to identify, assess, and control risks and opportunities to fulfill the mission of the organization.

• Thinking Critically:The ability to objectively question, analyze, interpret, and evaluate information to form a conclusion.

  Civil Service test score is required in order to be considered for this vacancy.

To apply for this vacancy, click on the “Apply” link above and complete an electronic application, which can be used for this vacancy as well as future job opportunities. Applicants are responsible for checking the status of their application to determine where they are in the recruitment process. Further status message information is located under the Information section of the Current Job Opportunities page.

*Resumes WILL NOT be accepted in lieu of completed education and experience sections on your application. Applications may be rejected if incomplete.

Note regarding the advertised pay range: The advertised maximum amount listed is the maximum salary a person can make while in this title/level over their career and not the maximum amount we are allowed to pay a new hire. Compensation will be based on qualifications, experience, and skills.

For further information about this vacancy contact:

Aiesha C. Zapata

Human Resources Business Partner

aiesha.carter-zapata@mhsdla.org

Minimum Qualifications

MINIMUM QUALIFICATIONS:

A baccalaureate degree plus three years of professional level experience in hospital or nursing home administration, public health administration, social services, nursing, pharmacy, dietetics/nutrition, physical therapy, occupational therapy, medical technology, or surveying and/or assessing health or social service programs or facilities for compliance with state and federal regulations.

SUBSTITUTIONS:

A current valid Louisiana license in one of the qualifying fields will substitute for the required baccalaureate degree.

A master's degree in hospital administration, nursing home administration, public health administration, social work, nursing, pharmacy, dietetics, nutrition, physical therapy, occupational therapy, or medical technology will substitute for a maximum of one year of the required experience.

NOTE:

Any college hours or degree must be from an accredited college or university.

NOTE:

A current valid Louisiana license in an individual field may be required for some positions.

NECESSARY SPECIAL REQUIREMENT:

FOR HEALTH STANDARDS SECTION JOBS ONLY

Federal regulations may mandate additional requirements prior to appointment.

Job Concepts

FUNCTION OF WORK:

To conduct surveys and/or assessments to verify that the services provided to individuals by providers, facilities, waivers, and/or long term care programs are in compliance with federal certification, state regulations, and established state standards. The Medical Certification Specialist 2 (Med Cert) manages a caseload of recipients who are linked for a Home and Community Based Waiver (HCBW). Receives and reviews in detail all components of an individual's initial comprehensive plan of care for approval for home and community-based services deciding within 10 business days of receipt as identified in federal and state guidelines. Minimum components of the plan of care includes: Medicaid Form 148 (information regarding Admissions/Discharges/Status Changes), 90L (medical information), Behavior Support Plan, Staffing Plan/Emergency Preparedness Information, Wavier Rights and Responsibilities, Freedom of Choice for Support Coordination, and Service Agency, Home/Worksite Diagram, as well as, Comprehensive Plan of Care outlining all information regarding person's disability, social supports, medical/psychiatric/psychological information, hours of staff support requested, financial costs of services as requested, and non-waiver funded supports and services.

LEVEL OF WORK:

Advanced.

SUPERVISION RECEIVED:

Broad direction from Medical Certification Supervisor or other higher level agency administrator.

SUPERVISION EXERCISED:

None.

LOCATION OF WORK:

Department of Health and Hospitals.

JOB DISTINCTIONS:

Differs from Medical Certification Specialist 1 by the possession of the Centers for Medicare and Medicaid Services certification and by the level of independence exercised in carrying out work responsibilities.

Differs from Medical Certification Supervisor by the absence of supervisory responsibilities.

Examples of Work

EXAMPLES LISTED BELOW ARE BRIEF SAMPLES OF COMMON DUTIES ASSOCIATED WITH THIS JOB TITLE. PLEASE NOTE THAT NOT ALL TASKS ARE INCLUDED.

Conducts surveys of health and social services programs, facilities, and providers that are state licensed and/or certified for state and federal programs.

Conducts assessments to ensure receipt of quality services by contracted providers.

Studies the facility or other enrolled providers relative to quality of medical services to determine the extent of compliance with state/federal regulations, state licensing, or established state standards.

Obtains information from review of records, staff interviews, resident interviews, personal observations relative to the operation of the medical facility, compliance standards, and quality of medical care provided.

Evaluates equipment and environmental factors of a facility for compliance with federal and state regulations.

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.

Evaluates the appropriateness and the quality of medical care based on personal observations, resident interviews, or established state performance standards.

Presents survey findings to staff and/or governing bodies of facilities.

Conducts special investigations in response to complaints and reports findings.

Certify individuals as medically eligible to receive waiver services.

Creates and monitors a continuous quality improvement process.

Approves waiver recipient comprehensive plan of care and annually evaluates the overall effectiveness of waiver recipient comprehensive plan of care. Ensures that personal outcomes resulting from the receipt of waiver services are reflective of the person-centered goals identified in their comprehensive plan of care.

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.

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.

Louisiana State Government represents a wide variety of career options and offers an outstanding opportunity tomake a differencethrough public service. With an array of career opportunities in every major metropolitan center and in many rural areas, state employment provides an outstanding option to begin or continue your career.

As a state employee, you will earn competitive pay, choose from a variety of benefits, and have access to a great professional development program:

Insurance Coverage More information can be found at https://info.groupbenefits.org/

Parental Leave– Up to six weeks paid parental leave

More information can be found athttps://www.civilservice.louisiana.gov/Parental-Leave/Default.aspx

Holidays and Leave – State employees receive the following paid holidays each year:

• New Year's Day

• Martin Luther King, Jr. Day,

• Mardi Gras,

• Good Friday,

• Memorial Day,

• Independence Day,

• Labor Day,

• Veteran's Day,

• Thanksgiving Day and Christmas Day.

* Additional holidays may be proclaimed by the Governor

State employees earn sick and annual leave which can be accumulated and saved for future use. Your accrual rate increases as your years of service increase.

Retirement – State of Louisiana employees are eligible to participate in various retirement systems (based on the type of appointment and agency for which an employee works). These retirement systems provide retirement allowances and other benefits for state officers and employees and their beneficiaries. State retirement systems may include (but are not limited to):

• Louisiana State Employees Retirement System (www.lasersonline.org). LASERS has provided this video (https://lasersonline.org/wp-content/uploads/2016/07/Your_Retirement_System.mp4) to give you more detailed information about their system

• Teacher's Retirement System of Louisiana (www.trsl.org),

• Louisiana School Employees Retirement System (www.lsers.net), among others

  01

  DA: Rate your ability to demonstrate accountability based on our definition: The ability to accept ownership for your actions, behaviors, performance, and decisions.

• 1= I have no experience and/or am uncomfortable demonstrating accountability

• 2= I have limited experience or require assistance to demonstrate accountability

• = I can demonstrate accountability

• I can demonstrate accountability and help others improve their ability to demonstrate accountability

  02

  DA: Explain your rating by providing specific and relevant examples in the box below.

  03

  DPe: Rate your ability to develop performance based on our definition: The ability to assist others in advancing their skills, knowledge, and performance levels over time.

• DPe: Rate your ability to develop performance based on our definition: The ability to assist others in advancing their skills, knowledge, and performance levels over time.

• 2= I have limited experience or require assistance to develop performance

• 3= I can develop performance

• 4= I can develop performance and help others improve their ability to develop performance

  04

  DPe: Explain your rating by providing specific and relevant examples in the box below.

  05

  4= I can develop performance and help others improve their ability to develop performance

• 1= I have no experience and/or am uncomfortable following policies and procedures

• 2= I have limited experience or require assistance to follow policies and procedures

• 3= I can follow policies and procedures

• 4= I can follow policies and procedures and help others improve their ability to follow policies and procedures

  06

  FPP: Explain your rating by providing specific and relevant examples in the box below.

  07

  TCr: Rate your ability to think critically based on our definition: The ability to objectively question, analyze, interpret, and evaluate information to form a conclusion.

• 1= I have no experience and/or am uncomfortable thinking critically

• 2= I have limited experience or require assistance to think critically 3= I can think critically

• 3= I can think critically

• 4= I can think critically and help others improve their ability to think critically

  08

  TCr: Explain your rating by providing specific and relevant examples in the box below.

  09

  Do you have Microsoft Office Suite experience (especially Excel) ?

• Yes

• No

  10

  Do you have experience in ISIS and/or LaGov? If you have no previous experience, type N/A.

  11

  Do you possess a certificate of completion from a medical assistant training program earned at a college or technical institute accredited by the Commission on Accreditation of Allied Health Education Programs or the Accrediting Bureau of Health Education Schools?

• Yes

• No

  12

  Do you possess a bachelor's degree?

• Yes

• No

  13

  How any years of medical certification experience do you have?

  Required Question

Agency

State of Louisiana

Address

For agency contact information, please refer to

the supplemental information above.

Louisiana State Civil Service, Louisiana, 70802

Phone

(866) 783-5462

Website

http://agency.governmentjobs.com/louisiana/default.cfm

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