Long Term Care Specialist I

State of Vermont; Rutland (VT); On-site; USD 52,000 - 76,000; Full time

Benefits offered by this job

Health benefits

Paid holidays

Retirement savings plan

Job summary

State of Vermont, Department of Vermont Health Access (DVHA), is seeking a Long Term Care Specialist I to manage caseloads, determine ongoing eligibility, and ensure timely processing within federal timelines. The role supports access to Medicaid services and requires independent work and strong rule interpretation.

Responsibilities include preparing reports, facilitating fair hearing requests, and potentially testifying.

Qualifications

• Bachelor's Degree required; related field preferred.
• Associates degree with 2+ years in healthcare admin, insurance, banking, or grants management.
• High School diploma with 3+ years in related fields and ability to interpret complex rules.

Responsibilities

• Maintain control of caseload to assure prompt processing of all case actions.
• Re-determines program eligibility at prescribed time frames or changes in client circumstances.
• Prepare reports, fair hearing requests and referrals; may testify at hearings.
• Work independently with limited mentor review and meet federal timelines.

Education

Bachelor's Degree

Associates degree

High School diploma or equivalent

Job description

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The Department of Vermont Health Access (DVHA)'s mission is to improve the health and well-being of Vermonters by providing access to quality healthcare cost effectively. We have three priorities that support us in moving our mission forward: Adoption of value-based payments, management of information technology projects, and operational performance improvement. Our department commits to executing our responsibilities and priorities while adhering to three core values: Transparency, Integrity and Service.

DVHA's Long Term Care Unit is seeking a qualified individual to join their dynamic team. The specialist maintains effective control of caseload to assure prompt processing of all case actions. Staff at this level are able to work independently and rely upon their own knowledge base of Medicaid rules. They are able to research and interpret rules independently. Staff at this level have less frequent review of their cases by mentors and supervisors. They are required to take refresher training as appropriate. Re-determines program eligibility at prescribed time frames or when changes in client circumstances dictate review. The specialist must complete work in a timely and efficient manner as there are federal timelines standards that the department is held to. Failure to adhere to those standards may result in financial penalties for the department.

May prepare reports, fair hearing requests and fraud referrals. May testify at Fair Hearings. Performs related duties and other assigned duties as required.

Mission: The Department of Vermont Health Access (DVHA)'s mission is to improve Vermonters' health and well-being by providing access to high-quality, cost-effective health care. We have identified three priorities that support our mission: Advancing value-based payments, modernizing information technology infrastructure, and operational performance improvement. Our department commits to executing our responsibilities and priorities while adhering to three core values: Transparency, Integrity and Service.

Diversity, Equity, and Inclusion: As part of our values of transparency, integrity, and service, we are committed to supporting diversity, equity, inclusion, and accessibility as part of our person-centered culture. We actively celebrate our colleagues' and future colleagues' different abilities, racial identity, sexual orientation, ethnicity, age, and gender. Everyone is welcome and supported here.

Our State: Vermont is a \"small but mighty\" state. We are ranked as one of the top 10 states to raise a family in 2022. We are nationwide leaders for progressive social and educational policies. We are in Northern New England, 1.5 hours from Montreal and 3.5 hours from Boston. We have beautiful Lake Champlain, the Green Mountains, and year-round outdoor activities.

Who May Apply

This position, Long Term Care Specialist I (Job Requisition #56104), is open to all State employees and external applicants. If you would like more information about this position, please contact [e-mail]. Please note that multiple positions in the same work location may be filled from this job posting.

AHS BACKGROUND CHECKS: Candidates must pass any level of background investigation applicable to the position. In accordance with AHS Policy 4.02, Hiring Standards, Vermont and/or national criminal record checks, as well as DMV and adult and child abuse registry checks, as appropriate to the position under recruitment, will be conducted on candidates, with the exception of those who are current classified state employees seeking transfer, promotion or demotion into an AHS classified position or are persons exercising re-employment (RIF) rights.

Duties are performed largely in an office setting. Workload usually heavy with constant need for prompt and accurate decisions. May experience frequent interruptions and shifting of priorities. Incumbents must be able to function independently. Private means of transportation should be available for necessary travel to training, mentoring and/or meetings. Applicants may provide a variety of challenges including but not limited to highly emotional conditions: belligerency, inability to communicate, attempts at falsification and total discouragement. May communicate with private attorneys engaged by applicants to help client with Long Term Care application and eligibility process. May consult with DVHA and/or AAG attorneys regarding fair hearings, extraordinary eligibility issues, rules interpretation or to gain assistance in responding to questions from client’s assistors or outside attorneys.

Minimum Qualifications

Bachelor's Degree

OR

Associates degree AND two (2) years or more of experience in a field related to health care administration, insurance, banking, accounting, para-legal services, auditing, or federal grants management. Other related work environments may be considered if they require: reading, comprehension and application of complex rules, regulations, policies, and procedures to perform the work.

OR

High School diploma or equivalent AND three (3) years or more of experience in a field related to health care administration, insurance, banking, accounting, para-legal services, auditing, or federal grants management. Other related work environments may be considered if they require: reading, comprehension and application of complex rules, regulations, policies, and procedures to perform the work.

Total Compensation

As a State employee you are offered a great career opportunity, but it's more than a paycheck. The State's total compensation package features an outstanding set of employee benefits that are worth about 30% of your total compensation, including:

• 80% State paid medical premium and a dental plan at no cost for employees and their families


• Work/Life balance: 12 paid holidays each year and a generous leave plan


• State Paid Family and Medical Leave Insurance (FMLI)


• Two ways to save for your retirement: A State defined benefit pension plan and a deferred compensation 457(b) plan


• Tuition Reimbursement


• Flexible spending healthcare and childcare reimbursement accounts


• Low cost group life insurance


• Incentive-based Wellness Program


• Qualified Employer for Public Service Student Loan Forgiveness Program

The State of Vermont celebrates diversity, and is committed to providing an environment of mutual respect and meaningful inclusion that represents a variety of backgrounds, perspectives, and skills. The State does not discriminate in employment on the basis of race, color, religion or belief, national, social or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, membership in an employee organization, family medical history or genetic information, or family or parental status. The State’s employment decisions are merit-based. Retaliatory adverse employment actions by the State are forbidden.