Medical Specialist Job at State of Louisiana

State of Louisiana Baton Rouge, LA

$27.09 - $51.15 an hour
Supplemental Information


This position is located within the Louisiana Department of Health / Office of Aging and Adult Services / Headquarters / East Baton Rouge Parish

Announcement Number: OAAS/SP/176683
Cost Center: 3201022002
Position Number(s): 50667874

This vacancy is being announced as a Classified position and will be filled as a part-time WAE appointment.

**Please note** Part-time WAE appointments are temporary and may last up to a year. Employees can only work a total of 1,245 hours within a year.

No Civil Service test score is required in order to be considered for this vacancy.

The maximum amount listed for this job title is the maximum salary a person can make in the position. It is not the maximum amount that we are allowed to pay a new hire.

Position will be based out of an office. Periodic travel within a single region will be required.

Occupational Summary
The position is domiciled at one of the nine Office of Aging and Adult Services (OAAS) regional Offices. The incumbent may travel to other regions of the state, depending on the specific duties assigned. The position is established to perform duties in order to implement and monitor the operations of all long term car eprograms that serve the elderly and persons with adult onset disaiblites. Incumbent performs duties, including but not limited to, managing waiver participants' certification, issuing denial/discharge notices with appeal rights as appropriate, completing in field Nursing Facility Level of Care (NFLOC) determinations with indviduals and participants, conducting Support Coordination Agency (SCA) monitoring (on-site and data review), providing technical assistance to Direct Service Providers (DSPs) and SCAs, conducting participant home visits, and delivering training to SCAs and DSPs statewide. The tasks are completed as necessary for effective operation of the programs, while remaining in compliance with federal requirements and ensuring the quality of care for individuals receiving services.

Incumbent must demonstrate knowledge of state and federal Medicaid guidelines and LDH/OAAS rules, policies and procedures in addition to knowledgte of the service system for all Medicaid Long Term Care Programs, including Nursing Facilities, Community Choices Waiver (CCW), Adult Day Health Care (ADHC) Waiver, Long-Term-Personal Care Services (LT-PCS), the Program for the All-Inclusive Care for the Elderly (PACE), and community resources.

Adheres to pertinent laws, rules, regulations, policies, and procedures of LDH, OAAS, Civil Service and appropriate state and federal licensing and governing bodies.

Performs other duties as necessary.

ESSENTIAL DUTIES:
30% Waiver Management
Ensures that all individuals initially and annually thereafter certified for waiver meet waiver admission criteria, including health and safety assurances. Maintains a caseload, both of individuals initially linked to waiver and those certified in waiver, to ensure timely certification and reduce the waiver services waitlist. Prepares and submits cases to the OAAS Service Review Panel (SRP) for case guidance as necessary. Issues waiver denial and discharge notices with appeal rights as appropriate to individuals not meeting or no longer meeting wavier admission criteria within notification timelines. Completes Summary of Evidence (SOE) packets for all waiver appeal hearings and actively represents the Department in appeal hearings with the Division of Administrative Law.

10% Certification/Training
Achieves and maintains assessment tool and care planning certification necessary to ensure the effective operation of the programs, compliance with federal requirements and quality of care for individuals receiving Home and Community Based Services (HCBS). With respect to the certification training, all OAAS medical certification specialists, medical certification specialist supervisors, support coordinators and supervisors in the support coordination agencies (which are private companies operating under agreements with OAAS and Medicaid) must successfully pass this training and be certified by OAAS in order to work in the long term care programs operated by OAAS.

5% Technical Assistance
Provides technical assistance regarding all OAAS programs to ensure continuity and effective delivery of comprehensive services to all participants. Provides technical assistance and guidance to support coordination agencies and direct service providers on program policy and procedures as well as on complex care and service issues involving individual recipients of services. Conducts quarterly meetings with support coordination agencies and direct service providers to discuss program operations and provide assistance and guidance regarding projects and/or programs.

20% Support Coordination Monitoring
Conducts monitoring reviews of all support coordination agencies and a representative sample of all participants at least annually utilizing specially developed program monitoring tools. This includes both on-site and in-home reviews, interviews and record reviews as well as ongoing review of performance data.
Assesses, scores, and documents monitoring data and findings. Applies the monitoring results to determine the remediation required and its severity for the agency and on behalf of the participant. Reviews, approves and provides feedback on the agency plans of corrective action and strategy to ensure that plans of correction are implemented and effective. Places support coordination agencies with repeated noncompliance on higher stringent levels of corrective action. Recommends termination of agency performance agreements to OAAS management based on agency performance or lack thereof. Collaborates with the LDH Health Standards Section as necessary.

10% Participant Critical Incident Reporting
Responsible for managing the reporting, review of and response to critical incidents by direct service providers and support coordinators. Incumbent has the responsibility for assuring that all health and welfare follow-up has been accomplished by providers. Oversees and as needed, directs the critical incident actions of the support coordinators and direct service providers. Assures that all appropriate actions have been taken to protect the participant from harm and that all medical or other services were provided, to prevent or mitigate the recurrence of similar critical incidents. Collaborates with Adult or Elderly Protective Services, Program Integrity, LDH Health Standards Sections, and the Attorney General’s office, as required.

20% Nursing Facility Outreach, Connection to Services and Level of Care Determinations
Responsible for performing on site level of care visits to review admissions to nursing facilities to assure that recently admitted individuals continue to meet nursing facility level of care and are appropriate for continued stay in the facility. Serves as the Local Contact Agency (LCA) for all nursing facility referrals through the Section Q
Referral process. Responsible for contacting the resident referred to OAAS by nursing facilities, identified through the Minimum Data Set assessment. Contacts the resident in a timely manner providing information about home and community based services (HCBS) and other long term care supports available in the community appropriate to the resident’s needs. Collaborates with the nursing facility to organize the resident’s transition to community living if possible.

Assists with the Department of Justice’s led My Choice Louisiana project to ensure individuals with serious mental illness in nursing facilities are in the most appropriate setting and have the opportunity to successfully discharge into the community with services sufficient to meet their needs. Incumbent completes level of care assessments with these identified individuals and conducts in person outreach visits to provide information regarding HCBS, the benefits of transition to the community, respond to questions regarding transition and support the individual in making an informed decision.

5% Other Responsibilities
Contributes to policies and procedures related to program operations. Serves as the point of contact for the public, private agencies, contractors and/or providers, participants and family members seeking more information or assistance with HCBS or in regards to policy and procedures of OAAS programs. Actively participates as required in various OAAS meetings, both on a state and regional level, including the service review panel, the mortality review committee, Requests for Proposal review panels, and other workgroups and quality committees as requested.
Responds and is available during statewide disaster/weather events (potential or otherwise) to provide reporting on participants’ evacuation and status. Reports to assigned LDH emergency response location when activated for emergency response duty assignments.

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.*

A resume upload will NOT populate your information into your application. Work experience left off your electronic application or only included in an attached resume is not eligible to receive credit

For further information about this vacancy contact:
Shambrielle Pooler
Shambrielle.Pooler@la.gov
LDH/HUMAN RESOURCES
BATON ROUGE, LA 70821

This organization participates in E-verify, and for more information on E-verify, please contact DHS at 1-888-464-4218.


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.
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.




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