MEDICAL CERTIFICATION SPECIALIST 1 or 2

• Certify applicants as medically eligible to received Medical Waiver Services. 
•  Analyze and review Comprehensive Plans of Care(CPOC) with required documentation to ensure that an individual meets medical eligibility for Waiver Services, initially and annually.
• 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.
• Returns incomplete plans to Support Coordination Agency and communicates the need regarding further information and why plan is deemed incomplete.
• Provides technical assistance to Support Coordination Agencies regarding methods of improving the incomplete plan.
• Utilizes professional medical knowledge and judgement in evaluation of appropriateness and quality of medical care by  assessing individual's overall health, welfare and safety, assuring that provided waiver services meet compliance.
• Conducts special investigations in response to complaints and prepares report findings.
• 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.
• 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.
• Consult with psychologist, psychiatrist, and/ or physician as needed to reach a final eligibility determination.
• Utilize professional nursing knowledge and judgment in assessing the delegation of medical tasks, procedures, and treatments to non-licensed staff.  
• 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.
• Incumbent completes/processes appropriate paperwork for waiver participants transferring into and out of other regions; and paperwork for discharges/closures/inactive status.
• Act as Liaison to non-waiver participants and other agency/entities.
• Certifies individuals as medically eligible to receive waiver services.
• Creates and monitors a continuous quality improvement process.
• Uses a variety of computer programs and web based systems that are specific to the waiver service delivery system.  

Appointment Type:  Job appointment, Probational, or Promotional (for current CAHSD employees only)

Location: Capital Area Human Services District's Developmental Disabilities Division.

Work Schedule: This position requires a total of 40 hours per week. Schedule will be determined based on operational needs. Work schedules may vary and can include:

• Eight (8) hour workdays
• Ten (10) hour workdays
• Nine (9) hour workdays for four (4) days and one (1) four (4) hour workday

Career Progression:  This position may be filled as a Medical Certification Specialist 1 or 2 depending on the level of experience of the selected applicant(s).

• The maximum annual salary for the Medical Certification Specialist 2 is $120,744.00.

**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.

How To Apply:

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.

*Information to support your eligibility for this job title must be included in the application (i.e., relevant, detailed experience/education). 

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

Contact Information: