Senior Nurse Specialist II - LTSS Clinical Lead

DC Government; Washington (District of Columbia); On-site; USD 90,000 - 110,000; Full time

Job summary

DC Government is seeking a healthcare professional to join the Department of Health Care Finance (DHCF) LTCA team. The role focuses on evidence-based LTSS acuity and medical necessity determinations for Medicaid LTSS programs, including HCBS, ICF/IID, and nursing facilities.

The incumbent will develop criteria, analyze trends, and present findings to leadership. The position requires a nursing license in the District of Columbia, appropriate degree, and experience in specialized LTSS settings.

Responsibilities

• Performs LTSS acuity and medical necessity determinations for Medicaid LTSS programs.
• Develops and updates criteria in line with clinical best practices and regulatory standards.
• Conducts risk stratification, quality audits, and analyzes service utilization across HCBS, ICF/IID, nursing facilities, and managed LTSS programs.
• Prepares and presents information via written documents, oral reports, and briefings.
• Collaborates with vendors, providers, and stakeholders; provides education and technical assistance.

Job description

DC Government is seeking a healthcare professional to join the Department of Health Care Finance (DHCF) LTCA team. The role focuses on evidence-based LTSS acuity and medical necessity determinations for Medicaid LTSS programs, including HCBS, ICF/IID, and nursing facilities.

The incumbent will develop criteria, analyze trends, and present findings to leadership. The position requires a nursing license in the District of Columbia, appropriate degree, and experience in specialized LTSS settings.