Medical Support Unit Nurse Supervisor

Title: Medical Support Unit Nurse Supervisor

State Role Title: Prog Admin Manager III

Hiring Range: $100,332 - $114,330

Pay Band: 6

Agency: Dept of Med Assistance Svcs

Location: Dept of Medical Asst Services

Agency Website: www.dmas.virginia.gov

Recruitment Type: General Public - G

Job Duties

The Department of Medical Assistance Services (DMAS) is excited to offer a competitive opportunity to serve as the Medical Support Unit Nurse Supervisor in the Office of the Chief Medical Officer.

Job responsibilities will include, but are not limited to:

Active Registered Nursing (RN) license in the Commonwealth of Virginia.

This position is responsible for management and oversight of maintaining and developing clinical policies and policy documents on behalf of the Medical Support Unit (MSU) within the Office of the Chief Medical Officer.

This position provides supervision and oversight to clinical authorization review within the Fee-for-service (FFS) program, reviews and evaluates new Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) billing codes, and helps to oversee aspects of clinical policy development.

Communicates in writing and verbally with providers, updates corresponding Medicaid manuals, and issues agency wide recommendations on issues associated with claims payments, rate issues, internal adjudication processes, billing procedures, and other functions as assigned.

Provides Division Director support on policy and procedural issues. Creates decision briefs, project plans, studies, and analyses as needed.

Located in beautiful Central Virginia, the Richmond area puts you just 2 hours from the Blue Ridge Mountains, Virginia Beach and Washington DC. To learn more about the Richmond, VA area visit: https://www.virginia.org

The Department of Medical Assistance Services (DMAS) is working to improve the health and well-being of Virginians through access to high quality health care coverage.

DMAS wants talented individuals who can align their experience with the mission of the agency and its core values – service, collaboration, trust, problem solving and adaptability.

At the Department of Medical Assistance Services (DMAS) we encourage and promote that you Come as you are | Become who you want to be | That is our promise.

Minimum Qualifications

Competitive candidates will meet these minimum qualifications:

Knowledge of third-party health care delivery systems.

Knowledge of and experience using, utilization management resources (e.g., InterQual or MCG) to adhere to utilization management guidelines (i.e. NCQA).

Considerable work experience with billing codes (i.e. CPT/HCPCS) and determining coverage criteria.

Considerable knowledge of, and experience interpreting, evidence-based clinical guidelines.

Considerable work experience developing programs to resolve complex issues.

Experience utilizing Microsoft Office products.

Knowledge of and work-related experience analyzing, interpreting, and applying federal/state laws and regulations governing the administration of public payer programs (i.e. Medicare, Medicaid).

Experience adhering to deadlines.

Experience communicating and collaborating with internal/external stakeholders.

Working experience managing, directing, and evaluating the work of reports

Additional Considerations

Competitive candidates should meet these additional considerations:

Experience with state rules and regulations relating to the Commonwealth of Virginia and Department of Medical Assistance Services.

Special Instructions

You will be provided a confirmation of receipt when your application and/or résumé is submitted successfully. Please refer to “Your Application” in your account to check the status of your application for this position.

The Virginia Department of Medical Assistance Services (DMAS) does not offer employment-based Sponsorship. Selected candidates will have their work authorization completed using the E‐Verify Program.

The Department of Medical Assistance Services (DMAS) is an Executive Branch agency that will adhere to all policies and procedures, to include the Commonwealth’s Department of Human Resource Management Policy 1.61 Teleworking.

This position requires a fingerprint based Criminal History Background Check, Education Checks if applicable, Work History Verification with references.

This position requires the submission of a Statement of Economic Interest (financial disclosure).

If you wish to apply for a job with the Department of Medical Assistance Services, an application and/or resume for employment must be submitted electronically through this website. Mailed, faxed, emailed, or hand-delivered applications/resumes will not be accepted. Consideration for an interview is based solely on the relevant information presented in the state application and/or resume submitted before the closing date.

Applications and/or resumes should include relevant work history which indicates your qualifications for this position.

The Department of Medical Assistance Services practices fair and equal employment opportunity to all employees and applicants in accordance with applicable laws and regulations. It is our policy to prohibit discrimination on the basis of race, sex, color, national origin, religion, sexual orientation, gender identity, age, veteran status, political affiliation, genetics, or disability in the recruitment, selection, and hiring of its workforce.

In support of the Commonwealth’s commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth's Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their AHP Letter (formerly called a Certificate of Disability) provided by the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Service-Connected Veterans may also apply via the AHP if they also provide an AHP Letter. To request an AHP Letter, use this link: https://www.dars.virginia.gov/drs/cpid/PWContact.aspx or call DARS at 800-552-5019, or DBVI at 800-622-2155

The Department of Medical Assistance Services is a V3 certified state agency that provides hiring preference to veterans and members of the reserves and/or National Guard in support of executive order 29, (2010). If you are a Veteran or Spouse of a Veteran or Active Military Member, DMAS encourages you to apply and respond accordingly on your state application.

Contact Information

Name: DMAS Talent Acquisition

Phone: (804)-225-4407

Email: askhcdtalentacq@dmas.virginia.gov

In support of the Commonwealth’s commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their AHP Letter (formerly COD) provided by the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Service-Connected Veterans are encouraged to answer Veteran status questions and submit their disability documentation, if applicable, to DARS/DBVI to get their AHP Letter. Requesting an AHP Letter can be found at AHP Letter or by calling DARS at 800-552-5019.

Note: Applicants who received a Certificate of Disability from DARS or DBVI dated between April 1, 2022- February 29, 2024, can still use that COD as applicable documentation for the Alternative Hiring Process.