MEDICAL CERTIFICATION SPECIALIST 1-2 – State of Louisiana – Louisiana

This position is located within the Louisiana Department of Health / Office of the Secretary / Health Standards

This vacancy is being announced as a Classified position and may be filled as a Probationary or Promotional appointment.

Note: Preference may be given to Registered Nurses

Incumbent is located in the LDH/OS/Health Standards Section. This section is responsible for the licensing and certification of all healthcare programs located in the state. HSS currently licenses/certifies over 35 different healthcare provider types including over 8500 entities. These investigators require intense training and specialized certifications to achieve and maintain proficiency in determining compliance with the thousands of regulations that are inclusive of these programs. This compliance is required to ensure the health, safety and welfare of all citizens of this State who receive services in these licensed/certified healthcare facilities. The incumbent must have the knowledge, skills, abilities and training in the appropriate healthcare areas to ensure applicable standards of appropriate care are being followed. This requires a high level of critical thinking skills, autonomy and decision making skills in addition to intense investigation skills to determine regulatory compliance. The ever changing world of regulatory compliance requires that this incumbent be extremely dynamic with changing processes and a quick study to learn and apply these changing processes and interpretations. Failure to perform the duties in this position could adversely affect health related service delivery in the State and could result in millions of dollars in federal disallowance to the state and the interruption of health delivery to hundreds of thousands of consumers.

60% Conducts surveys with certified surveyor/surveyors on approximately 35 different health care providers/suppliers that operate in the State. This is done to determine conformity with state and federal regulations relative to licensure and certification which requires a broad knowledge of all state and federal program requirements. Conducts a facility review relative to organization, policies, and procedures, administration and quality of services to determine the extent of compliance with the state licensure standards and Medicare and Medicaid regulations. Obtains information from review of records, personnel interviews, resident interviews, and personal observations relative to the delivery of healthcare services and relative to the aspects of the operation of the facility and compliance standards. Compiles information derived from surveys, prepares reports on results of the surveys; describes findings as related to established program procedures and processes; determines conclusions based upon facts obtained, and formulate reports of these findings to enable the program desks to determine whether licensure or certification should be granted, denied, or altered depending upon established laws and regulations. When necessary, testifies in legal hearings relative to survey findings, Performs all surveys in a professional manner at all times, adheres to all assigned mandates, follows directions as given by supervisor, and assures accurate completion of duties in accordance with established state and federal guidelines and timelines. Participates in an ongoing quality assurance program to ensure program integrity.

40% Conducts special investigations with certified surveyor/surveyors in response to complaints and prepares reports of findings. Interprets state and federal regulations to providers/suppliers as needed. Cooperates with administrators of facilities and professional groups in the preparation and presentation of education programs for healthcare providers and staff. Participates in an ongoing quality assurance program to ensure program integrity.

As part of a Career Progression Group, vacancies may be filled from this recruitment as a Medical Certification Specialist 1 or 2 depending on the level of experience of the selected applicant(s). The maximum salary for the Medical Certification Specialist 2 is $106,392. Please refer to the ‘Job Specifications’ tab located at the top of the LA Careers ‘Current Job Opportunities’ page of the Civil Service website for specific information on salary ranges, minimum qualifications and job concepts for each level.

No Civil Service test score is required in order to be considered for this vacancy.

To apply for this vacancy, click on the “Apply” link above and complete an electronic application, which can be used for this vacancy as well as future job opportunities. Applicants are responsible for checking the status of their application to determine where they are in the recruitment process. Further status message information is located under the Information section of the Current Job Opportunities page.

*Resumes will not be accepted in lieu of job experience on the application. Failure to complete an application may result in your application being disqualified.*You must describe your actual duties as you will not be qualified based on job title alone.

A resume upload will NOT populate your information into your application.
Work experience left off your electronic application or only included in an attached resume is not eligible to receive credit

MINIMUM QUALIFICATIONS:

A baccalaureate degree plus two years of professional level experience in hospital or nursing home administration, public health administration, social services, nursing, pharmacy, dietetics/nutrition, physical therapy, occupational therapy, medical technology, or surveying and/or assessing health or social service programs or facilities for compliance with state and federal regulations.

SUBSTITUTIONS:

A current valid Louisiana license in one of the qualifying fields will substitute for the required baccalaureate degree.

A master’s degree in hospital administration, nursing home administration, public health administration, social work, nursing, pharmacy, dietetics, nutrition, physical therapy, occupational therapy, or medical technology will substitute for a maximum of one year of the required experience.

NOTE:

Any college hours or degree must be from a school accredited by one of the following regional accrediting bodies: the Middle States Commission on Higher Education; the New England Association of Schools and Colleges; the Higher Learning Commission; the Northwest Commission on Colleges and Universities; the Southern Association of Colleges and Schools; and the Western Association of Schools and Colleges.

NOTE:

A current valid Louisiana license in an individual field may be required for some positions.

FUNCTION OF WORK:

To conduct surveys and/or assessments to verify that the services provided to individuals by providers, facilities, waivers, and/or long term care programs are in compliance with federal certification, state regulations, and established state standards.

LEVEL OF WORK:

Experienced.

SUPERVISION RECEIVED:

Broad review from Medical Certification Supervisor or other higher level agency administrator.

SUPERVISION EXERCISED:

None.

LOCATION OF WORK:

Department of Health and Hospitals.

JOB DISTINCTIONS:

Differs from Medical Certification Specialist 2 by the absence of Centers for Medicare and Medicaid Services certification and by the level of independence exercised in carrying out work responsibilities.

EXAMPLES LISTED BELOW ARE BRIEF SAMPLES OF COMMON DUTIES ASSOCIATED WITH THIS JOB TITLE. PLEASE NOTE THAT NOT ALL TASKS ARE INCLUDED.

Conducts surveys of health and social services programs, facilities, and providers that are state licensed and/or certified for state and federal programs.

Conducts assessments to ensure receipt of quality services by contracted providers.

Studies the facility or other Medicaid enrolled provider relative to quality of medical services to determine the extent of compliance with state/federal regulations, state licensing, or established state standards.

Obtains information from review of records, staff interviews, resident interviews, personal observations relative to the operation of the medical facility, compliance standards, and quality of medical care provided.

Evaluates equipment and environmental factors of the facility for compliance with federal and state regulations.

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.

Conducts special investigations in response to complaints and prepares report findings.

Certifies individuals as medically eligible to receive waiver services.

Creates and monitors a continuous quality improvement process.

Approves waiver recipients’ comprehensive plan of care and annually evaluates the overall effectiveness of waiver recipients’ comprehensive plan of care. Ensures that personal outcomes resulting from the receipt of waiver services are reflective of the person-centered goals identified in their comprehensive plan of care.

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.

Evaluates the appropriateness and the quality of medical care based on personal observations, interviews, and/or established state performance standards.

Receives, reviews, and determines appropriateness of recipient appeals of denied services. Gathers factual information and prepares summary of evidence. Presents testimony before Administrative Law Judge.