Medical certification specialist 1

Company Name:
Louisiana Department of State Civil Service
Agency: DHH-Aging and Adult Services
Opening Date: Thu. 04/24/14
Closing Date/Time: Thu. 04/24/14 11:59 PM Central Time
State Salary Range: $19.43 - $38.81 hourly
$3,368.00 - $6,727.00 monthly
Agency Hiring Range: Min: Max:
Job Type: Classified
Location: Monroe, Louisiana
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QualificationsBenefitsSupplemental Questions
A baccalaureate degree plus two 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.
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.
Any college hours or degree must be from a school accredited by one of the following regional accrediting bodies:the Middle States Commission on Higher Education; the New England Association of Schools and Colleges; the North Central Association of Colleges and Schools; the Northwest Commission on Colleges and Universities; the Southern Association of Colleges and Schools; and the Western Association of Schools and Colleges.
A current valid Louisiana license in an individual field may be required for some positions.
Supplemental Information:
This position is located within the Department of Health and Hospitals / Office of Aging Adult Services / Research & Management / Monroe, LA/ Ouachita Parish
Cost Center:0320-0047
Position Numbers: 50348977
This vacancy is being announced as a Classified position and may be filled as a Job appointment.
No Civil Service test scorerequired for this posting.
As part of a Career Progression Group, vacancies may be filled from this recruitment as aMedical CertificationSpecialist1 or 2 depending on the level of experience of the selected applicant(s).The maximum salary for theMedicalCertification Specialist2 is$86,382.00.Please refer to the 'Job Specifications' tab located at the top of the LA Careers 'Current Job Opportunities' page of the Civil Service website for specific information on salary ranges, minimum qualifications and job concepts for each level.
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 can check the status of their application at any time by selecting the 'Application Status' link after logging into their account.Below are the most common status messages and their meanings.
Resumes will not be accepted in lieu of job experience on application.
Application Status Message
What it Means
Application received
Your application has been submitted successfully.
Checking for required test score
We are making sure you have an active, passing score for the required written test.
Evaluating experience
Your application is being reviewed by Human Resources to ensure you meet the minimum qualifications for the position.
Eligible for consideration
You are among a group of applicants who MAY be selected for the position.
Referred to hiring manager for review
Your application has been delivered to the hiring manager.You may or may not be called for an interview.
Position filled
Someone has been selected for the position.
Position cancelled
The agency has decided not to fill the position.
There is no guarantee that everyone who applies to this posting will be interviewed.The hiring supervisor/manager has 90 days from the closing date of the announcement to make a hiring decision.Specific information about this job will be provided to you in the interview process, should you be selected.
For further information about this vacancy contact:
Casey Hickman, HR Analyst
Department of Health and Hospitals
Fax Number
Or write to :
Attn:Casey S. Hickman
PO Box 4818
Baton Rouge, LA 70821
This organization participates in E-verify, and for more information on E-verify, please contact DHS at .
Job Concepts:
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.
Broad review from Medical Certification Supervisor or other higher level agency administrator.
Department of Health and Hospitals.
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.

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