Quality Management Review Analyst

Title: Quality Management Review Analyst

State Role Title: Health Care Compliance Spec II

Hiring Range: $76,289 - $78,130

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 Quality Management Review Analyst in the High Needs Supports Division.

Job responsibilities will include, but are not limited to:

Quality Management Review (QMR) Analysts will work in the field to conduct on-site quality management reviews (QMR) to assure the health, safety, and welfare of individuals receiving Medicaid Long-Term Care Services through home and community-based waiver programs.

QMR Analysts will spend three to four overnights a week for three to four weeks of a month completing on-site reviews. Programs reviewed include and are not limited to: Family and Individual Supports Waiver, Building Independence Waiver, and Community Living Waiver. Based on the findings of the QMR, we may make a referral to the proper agency in most cases.

Staff will make decisions regarding health, welfare & safety of waiver enrollees, documentation compliance, and verify services, are rendered.

Staff provide training and/or technical assistance to providers and participate as subject matters experts in policy/procedure development.

The business needs for this position have in-office requirements to include but are not limited to attending in-person meeting periodically and travel throughout the state to complete audits.

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 the Developmental Disabilities Waivers and person-centered planning.

Considerable knowledge reviewing medical records and applying applicable regulations and generating letters reflecting the results of the reviews.

Knowledge of electronic health records; standards of treatment and medical terminology.

Knowledge of analyzing data and resolving problems; researching and identifying changes in program requirements and policies.

Knowledge of the use of personal computers, word processing and spreadsheet applications (Microsoft Suites).

Knowledge/Experience interpretation and application of federal, state laws/regulations.

Experience in meeting deadlines.

Experience with internal/external stakeholders.

Additional Considerations

There are no additional considerations for this position.

Special Instructions

You will be provided a confirmation of receipt when your application and/or résumé is submitted successfully. Please refer to “Your Application” in your account to check the status of your application for this position.

The Virginia Department of Medical Assistance Services (DMAS) does not offer employment-based Sponsorship. Selected candidates will have their work authorization completed using the E‐Verify Program.

The Department of Medical Assistance Services (DMAS) is an Executive Branch agency that will adhere to all policies and procedures, to include the Commonwealth’s Department of Human Resource Management Policy 1.61 Teleworking. This position could be expected to work in the office as driven by business needs.

This position requires a fingerprint based Criminal History Background Check, Education Checks if applicable, Work History Verification with references.

If you wish to apply for a job with the Department of Medical Assi