Medical Certification Specialist 1-2

The position 1s 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 care programs that serve the elderly and persons with adult-onset disabilities. Incumbent performs duties, including but not limited to, managing wavier participants certification: issuing denial/discharge notices with appeal rights as appropriate, completing in field Level of Care (LOC) determinations with individuals 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 knowledge of the service system for all Medicaid Long Term Care Programs, including Nursing Facilities, Community Choices Waiver, Adult Day Health Care 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 the Louisiana Department of Health (LDH), OAAS, Civil Service and appropriate state and federal licensing and governing bodies. Performs other duties as necessary.

20% Waiver Management

Ensures that all individuals initially and annually thereafter certified for waiver meet waiver admission criteria, including health and safety assurances. 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 the Summary of Evidence (SOE) packets for all waiver appeal hearings and actively represents the Department in the appeal hearing with the Division of Administrative Law.

20% Certification/Training

Organizes and conducts certification training and other trainings coordinators (case managers) direct service providers/workers 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 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. Specializes in conducting certification training on the assessment tool and care planning. Responsible for coaching and mentoring support coordinators in field-based activities as a component of the assessment and care planning competency evaluation. Responsible for certifying the competency of support coordinators in assessment and care planning and issuing certificates. Responsible for tracking and analyzing trends utilizing educational analytics. Coordinates training activities and schedules course logistics for the continuous improvement of support coordinator performance. Possesses knowledge and ability in adult learning principles, effective facilitation skills, critical thinking, and problem solving skills. Incumbent must also be knowledgeable in the relevant clinical skills necessary to serve as subject matter expert on the training content. For example, the incumbent must be certified in the application of the assessment and in person-centered care plan development. Confers with management to identify training needs based on processes, changes, and other factors. Contributes to the analysis, design and development of training materials 9related to specialized areas of expertise including but not limited to clinical issues, OAAS rules, regulations, policies and procedures, participant care, etc. Develops, organizes and delivers and evaluates training programs, including trainings, meetings and workshops for support coordination agencies and direct service providers.

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.

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.

This position is located within the Louisiana Department of Health / Office of Aging and Adult Services  /  Headquarters / Lafayette Parish
 
 Announcement Number:  OAAS/DPT/209516

 Cost Center: 3201022004

Position Number(s):  50542794

This vacancy is being announced as a Classified position and may be filled as a Probationary appointment.

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.

No Civil Service exam required. 

*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:

Debbie Parris-Thymes

Debbie.Parris-Thymes2@la.gov

LA Department of Health (LDH)

Division of Human Resources

Baton Rouge, LA 70821

225-342-6477

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