MEDICAL CERTIFICATION SPECIALIST 1 or 2

Posting number: 26-029-DD-MCS

Department: LDH-Capital Area Human Services District

Job classification: MEDICAL CERTIFICATION SPECIALIST 1

Posting type: Open & Promotional

Categories: Community Services, Mental Health, Social Services, Human Services, Counseling, Community and Social Services, Rehabilitation Services

Summary

Why work for CAHS?

• Vision: CAHS excel at making lives better.
• Mission: To deliver caring and responsive services, leading to a better tomorrow.
• Philosophy: CAHS commits to the philosophy that all individuals are valuable members of the community.  CAHS exist to help each person(s) served live productively in the location and environment of the choosing and abilities.  CAHS staff works as a unified team to provide services and supports that helps person(s) served succeed in work, school, life, and other endeavors they purse.

We are seeking a dedicated and detail-oriented Medical Certification Specialist to join our certification team and ensure the accurate, timely, and compliant delivery of Waiver Services. This rewarding role offers the opportunity to make a meaningful difference in the lives of individuals with developmental disabilities and their families throughout our district.

This position offers the opportunity to build professional relationships, contribute to quality service delivery, and positively impact the well-being of the individual and communities we serve.  If you are passionate about public service, enjoy working with diverse populations, and are dedicated to ensuring compliance while providing compassionate support, we encourage you to apply and become a valued member of our team.

Examples of duties

Qualifications

Supplemental information

• 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, a