Registered Nurse (RN) Clinical Analyst

Title: Registered Nurse (RN) Clinical Analyst

State Role Title: Health Care Compliance Spec II

Hiring Range: $60,788 - $92,000

Pay Band: 5

Agency: Dept of Med Assistance Svcs

Location: Dept of Medical Asst Services

Agency Website: www.dmas.virginia.gov

Recruitment Type: General Public - G

Job Duties

The Department of Medical Assistance Services (DMAS) is excited to offer a competitive opportunity to serve as the Registered Nurse (RN) Clinical Analyst. The selected competitive candidate will provide exceptional delivery of services to the Integrated Care Division.

Job responsibilities will include, but are not limited to:

Must be a Registered Nurse (RN) licensed to practice in the state of Virginia or the ability to obtain a license to practice in Virginia within the first three months of employment.

Responsible for clinical responsibilities of the Level of Care Review (LOCERI) process.

This includes providing secondary or higher level of reviews, data collection, data entry, communications with providers (Managed Care Organization (MCO) & Fee for Service (FFS)). Training of providers and representing Department of Medical Assistance (DMAS) in appeals associated with LOCERI.

The incumbent will be responsible for clinical responsibilities of the Level of Care Review (LOCERI) process.

This includes providing secondary or higher level of reviews, data collection, data entry, communications with providers (Managed Care Organization (MCO) & Fee for Service (FFS)). Training of providers and representing Department of Medical Assistance (DMAS) in appeals associated with LOCERI.

The incumbent will have Frequent contact with health care providers, program administrators, and representatives from state and federal agencies, and other direct and indirect human service providers to confer on policy problems and request legal opinions.

This position will apply rules, regulations, and laws in administration of programs.

As well as implementing and overseeing corrective actions. Lastly, this position renders decisions on unusual problems involving policy interpretation.

The business needs for this position have in office requirements to include but are not limited to mandatory in- person meetings, compiling, scanning, printing, and emailing appeal summaries and may be needed to print/mail Waiver separation letters/ Waiver Reinstatement letters and mailing Continued Enrollment During the Appeal letters to members.

Located in beautiful Central Virginia, the Richmond area puts you just 2 hours from the Blue Ridge Mountains, Virginia Beach and Washington DC. To learn more about the Richmond, VA area visit: https://www.virginia.org

The Department of Medical Assistance Services (DMAS) is working to improve the health and well-being of Virginians through access to high quality health care coverage.

DMAS wants talented individuals who can align their experience with the mission of the agency and its core values – service, collaboration, trust, problem solving and adaptability.

At the Department of Medical Assistance Services (DMAS) we encourage and promote that you Come as you are | Become who you want to be | That is our promise.

Minimum Qualifications

Competitive candidates will meet these minimum qualifications:

Considerable knowledge of Virginia Medicaid Long-Term Services and Supports (LTSS) requirements.

Considerable knowledge and work-related experience inclusive of Elderly or Disabled populations of various ages and medical diagnoses.

Considerable knowledge and work-related experience researching complex issues.

Knowledge of and adherence to policies and procedures.

Considerable experience with Excel spreadsheets.

Considerable work-related experience analyzing, interpreting, and applying federal, state laws and regulations.

Considerable work-related experience organizing and prioritizing work assignments and meeting deadlines.

Considerable experience communicating effectively in writing with internal and external stakeholders.

Must be a Registered Nurse (RN) licensed to practice in the state of Virginia or the ability to obtain a license to practice in Virginia within the first three months of employment.

Additional Considerations

There are no additional considerations for this position.

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