Job description

**THIS IS A PART TIME, WAE STATE POSITION**

**PERIODIC DAYTIME TRAVEL WITHIN ONE REGION (LDH REGION 2) IS REQUIRED**

LOUISIANA DEPARTMENT OF HEALTH, OFFICE OF AGING AND ADULT SERVICES

MEDICAL CERTIFICATION SPECIALIST 2

OCCUPATIONAL SUMMARY:

The position is domiciled at one of the nine Office of Aging and Adult Services (OAAS) regional Offices. The incumbent may travel to other regions of the state, depending on the specific duties assigned. The position is established to perform duties in order to implement and monitor the operations of all long term care programs that serve the elderly and persons with adult onset disabilities. Incumbent performs duties, including but not limited to, managing waiver participants' certification, issuing denial/discharge notices with appeal rights as appropriate, completing in field Nursing Facility Level of Care (NFLOC) determinations with individuals and participants, conducting Support Coordination Agency (SCA) monitoring (on-site and data review), providing technical assistance to Direct Service Providers (DSPs) and SCAs, conducting participant home visits, and delivering training to SCAs and DSPs statewide. The tasks are completed as necessary for effective operation of the programs, while remaining in compliance with federal requirements and ensuring the quality of care for individuals receiving services.

Incumbent must demonstrate knowledge of state and federal Medicaid guidelines and LDH/OAAS rules, policies and procedures in addition to knowledge of the service system for all Medicaid Long Term Care Programs, including Nursing Facilities, Community Choices Waiver (CCW), Adult Day Health Care (ADHC) Waiver, Long-Term-Personal Care Services (LT-PCS), the Program for the All-Inclusive Care for the Elderly (PACE), and community resources.

Adheres to pertinent laws, rules, regulations, policies, and procedures of LDH, OAAS, Civil Service and appropriate state and federal licensing and governing bodies.

Performs other duties as necessary.

ESSENTIAL DUTIES:

30% Waiver Management

Ensures that all individuals initially and annually thereafter certified for waiver meet waiver admission criteria, including health and safety assurances. Maintains a caseload, both of individuals initially linked to waiver and those certified in waiver, to ensure timely certification and reduce the waiver services waitlist. Prepares and submits cases to the OAAS Service Review Panel (SRP) for case guidance as necessary. Issues waiver denial and discharge notices with appeal rights as appropriate to individuals not meeting or no longer meeting wavier admission criteria within notification timelines. Completes Summary of Evidence (SOE) packets for all waiver appeal hearings and actively represents the Department in appeal hearings with the Division of Administrative Law.

10% Certification/Training

Achieves and maintains assessment tool and care planning certification necessary to ensure the effective operation of the programs, compliance with federal requirements and quality of care for individuals receiving Home and Community Based Services (HCBS). With respect to the certification training, all OAAS medical certification specialists, medical certification specialist supervisors, support coordinators and supervisors in the support coordination agencies (which are private companies operating under agreements with OAAS and Medicaid) must successfully pass this training and be certified by OAAS in order to work in the long term care programs operated by OAAS.

5% Technical Assistance

Provides technical assistance regarding all OAAS programs to ensure continuity and effective delivery of comprehensive services to all participants. Provides technical assistance and guidance to support coordination agencies and direct service providers on program policy and procedures as well as on complex care and service issues involving individual recipients of services. Conducts quarterly meetings with support coordination agencies and direct service providers to discuss program operations and provide assistance and guidance regarding projects and/or programs.

20% Support Coordination Monitoring

Conducts monitoring reviews of all support coordination agencies and a representative sample of all participants at least annually utilizing specially developed program monitoring tools. This includes both on-site and in-home reviews, interviews and record reviews as well as ongoing review of performance data.

Assesses, scores, and documents monitoring data and findings. Applies the monitoring results to determine the remediation required and its severity for the agency and on behalf of the participant. Reviews, approves and provides feedback on the agency plans of corrective action and strategy to ensure that plans of correction are implemented and effective. Places support coordination agencies with repeated noncompliance on higher stringent levels of corrective action. Recommends termination of agency performance agreements to OAAS management based on agency performance or lack thereof. Collaborates with the LDH Health Standards Section as necessary.

10% Participant Critical Incident Reporting

Responsible for managing the reporting, review of and response to critical incidents by direct service providers and support coordinators. Incumbent has the responsibility for assuring that all health and welfare follow-up has been accomplished by providers. Oversees and as needed, directs the critical incident actions of the support coordinators and direct service providers. Assures that all appropriate actions have been taken to protect the participant from harm and that all medical or other services were provided, to prevent or mitigate the recurrence of similar critical incidents. Collaborates with Adult or Elderly Protective Services, Program Integrity, LDH Health Standards Sections, and the Attorney General’s office, as required.

20% Nursing Facility Outreach, Connection to Services and Level of Care Determinations

Responsible for performing on site level of care visits to review admissions to nursing facilities to assure that recently admitted individuals continue to meet nursing facility level of care and are appropriate for continued stay in the facility. Serves as the Local Contact Agency (LCA) for all nursing facility referrals through the Section Q

Referral process. Responsible for contacting the resident referred to OAAS by nursing facilities, identified through the Minimum Data Set assessment. Contacts the resident in a timely manner providing information about home and community based services (HCBS) and other long term care supports available in the community appropriate to the resident’s needs. Collaborates with the nursing facility to organize the resident’s transition to community living if possible.

Assists with the Department of Justice’s led My Choice Louisiana project to ensure individuals with serious mental illness in nursing facilities are in the most appropriate setting and have the opportunity to successfully discharge into the community with services sufficient to meet their needs. Incumbent completes level of care assessments with these identified individuals and conducts in person outreach visits to provide information regarding HCBS, the benefits of transition to the community, respond to questions regarding transition and support the individual

in making an informed decision.

5% Other Responsibilities

Contributes to policies and procedures related to program operations. Serves as the point of contact for the public, private agencies, contractors and/or providers, participants and family members seeking more information or assistance with HCBS or in regards to policy and procedures of OAAS programs. Actively participates as required in various OAAS meetings, both on a state and regional level, including the service review panel, the mortality review committee, Requests for Proposal review panels, and other workgroups and quality committees as requested.

Responds and is available during statewide disaster/weather events (potential or otherwise) to provide reporting on participants’ evacuation and status. Reports to assigned LDH emergency response location when activated for emergency response duty assignments.

Job Type: Part-time

Pay: $4,389.00 - $8,285.00 per month

Schedule:

• Day shift
• Monday to Friday

Work Location: In person

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