MEDICAL CERTIFICATION SPECIALIST 1-2

State of Louisiana; Baton Rouge (LA); Vor Ort; USD 60.000 - 95.000; Vollzeit

Zusammenfassung

Louisiana Department of Health in Baton Rouge is seeking a qualified professional to join the Office of Aging and Adult Services. The role focuses on developing and revising policies, coordinating rulemaking, and overseeing OAAS Medicaid waiver programs to support older adults and individuals with disabilities.

Applicants should have a current Louisiana license or appropriate degree with relevant experience, along with strong analytical and collaborative skills to improve program operations and

Qualifikationen

• Current Louisiana license in a health services field, health regulation field, or social services field plus two years of relevant experience.
• Bachelor's degree plus two years of experience in hospital or nursing home administration, health services, health regulation, or social services.
• Master's degree in a health services, health regulation, or social services field plus one year of related experience.

Aufgaben

• Develop, review, and revise policies, procedures, applications, renewals, amendments, and state plan amendments for OAAS Medicaid waiver and state plan programs.
• Coordinate policy development and rulemaking to ensure compliance with state and federal laws and Medicaid requirements.
• Administer and oversee statewide appeals processes for OAAS programs, including LT-PCS, CCW, ADHC, and PACE.
• Review and analyze appeal requests, supporting docs, coordinate hearings, and represent OAAS at administrative hearings when needed.
• Develop and maintain appeals policies, procedures, manuals, forms, and training materials for consistent statewide implementation.

Jobbeschreibung

The mission of the Louisiana Department of Health is to protect and promote health and to ensure access to medical, preventive, and rehabilitative services for all residents of the State of Louisiana.

Learn more about Louisiana Department of Health

This position may be filled in the following parish(es): East Baton Rouge

Make a meaningful impact on the lives of Louisiana’s older adults and individuals with disabilities! Join the Office of Aging and Adult Services (OAAS) and help strengthen programs that provide essential long-term care and support services. This position reports to work in-person to the Bienville Building 5 days per week and works directly under the supervision of the OAAS Policy Development Level of Care Medical Certification Manager 2. Be part of a team dedicated to expanding choices, promoting quality care, and helping individuals maintain their independence, dignity, and quality of life.

• A current Louisiana license in a health services field, health regulation field, or social services field plus two years of experience in hospital or nursing home administration, health services, health regulation, or social services; OR
• A bachelor's degree plus two years of experience in hospital or nursing home administration, health services, health regulation, or social services; OR
• A master's degree in a health services field, health regulation field, or a social services field plus one year of experience in hospital or nursing home administration, health services, health regulation, or social services.

Job Duties

• Develop, review, and revise policies, procedures, applications, renewals, amendments, and State Plan Amendments for OAAS Medicaid waiver and state plan programs.
• Coordinate policy development and rulemaking activities to ensure compliance with applicable state and federal laws, regulations, and Medicaid requirements.
• Administer and oversee statewide appeals processes for OAAS programs, including LT-PCS, CCW, ADHC, and PACE, ensuring compliance with established procedures and deadlines.
• Review and analyze appeal requests, supporting documentation, and evidence; coordinate hearings, resolve issues, and represent OAAS at administrative hearings as needed.
• Develop and maintain appeals policies, procedures, manuals, forms, and training materials to support consistent statewide implementation.
• Provide technical assistance, guidance, and subject matter expertise to OAAS staff, contractors, and stakeholders regarding program requirements, appeals, and compliance.
• Monitor appeals activities, contractor performance, service authorizations, and program reports to identify operational issues and recommend corrective actions.
• Evaluate program operations, address audit findings, and collaborate with management to implement policy revisions and quality improvement initiatives.
• Oversee program documentation and operation systems while ensuring compliance with federal regulations, CMS requirements and LDH policies.
• Prepare reports and recommendations for management and governmental entities, participate in special projects, and perform other duties as assigned.
• Adhere to applicable laws, rules, regulations, policies, and procedures of LDH, OAAS, Civil Service, and appropriate state/federal licensing and governing bodies.
• Participate in special projects as needed, as well as performs other duties assigned by supervisors for smooth and effective operation of the agency and of the OAAS programs.
• Work in the OAAS, state office, Monday-Friday, during business hours to ensure team collaboration and operational needs.

Position-Specific Details

Location: Office of Aging and Adult Services / AD POLICY DEVELOPMENT-SO / East Baton Rouge Parish

Appointment Type:This position may be filled as aProbationary appointment or Promotional appointment

Cost Center:3201020500

Position Number(s): 135102

Career Progression: This position may be filled as a Medical Certification Specialist 1 or 2 determined by the qualifications of the candidate selected. This position provides the opportunity to advance within this job series.

Applicants with the following are encouraged to apply:

• A current interRAI-HC certification from OAAS.
• Knowledge of state and federal guidelines and agency policies and procedures in addition to knowledge of the Medicaid service system for Long Term Care and Home and Community-Based Services (HCBS).
• Knowledge of the appeal process to ensure that all appeals are processed in accordance with established requirements and timelines.

Debbie Parris-Thymes

[e-mail]

LA Department of Health (LDH)

Division of Human Resources

PO Box 4818

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.

LDH supports Louisiana’s commitment to being a State as a Model Employer (SAME) by promoting the recruitment, hiring, and retention of individuals with disabilities.

Information on the Louisiana Works, Louisiana Rehabilitation Services is available here.

LDH is an equal opportunity employer and seeks to recruit a highly productive and diverse workforce and will provide equal employment opportunities to all employees and prospective employees. Employment decisions shall be based strictly on merit and without regard to religious or political beliefs, sex, race, or any other non-merit factor.