What are the responsibilities and job description for the Medical Certification Specialist 1-2 position at Louisiana Department Of Transportation and Development?
Supplemental Information
The Louisiana Department of Health is dedicated to fulfilling its mission through direct provision of quality services, the development and stimulation of services of others, and the utilization of available resources in the most effective manner.
LDH serves as a model employer for individuals with disabilities.
This position is located within the Louisiana Department of Health / Office Aging and Adult Services / Rapides Parish
Announcement Number: OAAS/ABM/208170
Cost Center: 3201022106
Position Number(s): 162832
This vacancy is being announced as a Classified position and may be filled as a Job appointment, Probationary or Promotional appointment.
No 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.
For Further Information About This Vacancy Contact
Alanna McCollum
Alanna.McCollum@la.gov
LDH/Human Resources
Baton Rouge, LA
225 342-6477
This organization participates in E-verify, and for more information on E-verify, please contact DHS at 1-888-464-4218.
Minimum Qualifications
MINIMUM QUALIFICATIONS:
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; OR
A bachelor's degree plus two 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 one year of experience in hospital or nursing home administration, health services, health regulation, or social services.
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.
Level Of Work
Experienced.
Supervision Received
Broad review 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 2 by the absence of Centers for Medicare and Medicaid Services certification and by the level of independence exercised in carrying out work responsibilities.
Examples of Work
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 Medicaid enrolled provider 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 the 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.
Conducts special investigations in response to complaints and prepares report findings.
Certifies individuals as medically eligible to receive waiver services.
Creates and monitors a continuous quality improvement process.
Approves waiver recipients' comprehensive plan of care and annually evaluates the overall effectiveness of waiver recipients' 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.
Evaluates the appropriateness and the quality of medical care based on personal observations, interviews, and/or established state performance standards.
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.
The Louisiana Department of Health is dedicated to fulfilling its mission through direct provision of quality services, the development and stimulation of services of others, and the utilization of available resources in the most effective manner.
LDH serves as a model employer for individuals with disabilities.
This position is located within the Louisiana Department of Health / Office Aging and Adult Services / Rapides Parish
Announcement Number: OAAS/ABM/208170
Cost Center: 3201022106
Position Number(s): 162832
This vacancy is being announced as a Classified position and may be filled as a Job appointment, Probationary or Promotional appointment.
No 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.*
For Further Information About This Vacancy Contact
Alanna McCollum
Alanna.McCollum@la.gov
LDH/Human Resources
Baton Rouge, LA
225 342-6477
This organization participates in E-verify, and for more information on E-verify, please contact DHS at 1-888-464-4218.
Minimum Qualifications
MINIMUM QUALIFICATIONS:
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; OR
A bachelor's degree plus two 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 one year of experience in hospital or nursing home administration, health services, health regulation, or social services.
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.
Level Of Work
Experienced.
Supervision Received
Broad review 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 2 by the absence of Centers for Medicare and Medicaid Services certification and by the level of independence exercised in carrying out work responsibilities.
Examples of Work
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 Medicaid enrolled provider 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 the 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.
Conducts special investigations in response to complaints and prepares report findings.
Certifies individuals as medically eligible to receive waiver services.
Creates and monitors a continuous quality improvement process.
Approves waiver recipients' comprehensive plan of care and annually evaluates the overall effectiveness of waiver recipients' 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.
Evaluates the appropriateness and the quality of medical care based on personal observations, interviews, and/or established state performance standards.
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.
