Compliance & Utilization Specialist

Title: Compliance & Utilization Specialist

State Role Title: Policy Planning Spec II

Hiring Range: $76,636 - $97,850

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 Compliance & Utilization Specialist in the High Needs Support Division.

Job responsibilities will include, but are not limited to:

The chief objective of this position is to serve as the Compliance and Utilization Specialist for the home and community-based [HCBS] waiver services across the Commonwealth – with primary focus on services licensed by both the Department of Behavioral Health and Developmental Services and the Virginia Department of Health.

Based upon statewide travel expectations, position is considered field based.

The position regularly engages with DMAS Program Integrity, DMAS Quality Management Reviews Team, as well as following up on HCBS Waiver referrals to the Office of the Attorney General (OAG) and the Medicaid Fraud Control Unit (MFCU).

The position maintains effective communication and engagement with DMAS Fiscal Services with regards to the identification and potential retraction of Medicaid funds from enrolled providers found to be in non-compliance.

Additional duties may include – work with developing and updating Waiver regulations and provider manuals; completing Root Cause Analysis on systemic issues identified within the utilization review process; and project management as needed.

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 1915c Home and Community Based Waiver Services across the Commonwealth of Virginia.

Considerable knowledge of completing Root Cause Analysis, as it pertains to systemic improvement and compliance.

Considerable experience with developing and evaluating program policies and procedures; developing and implementing regulations and assessing operations for effectiveness.

Considerable knowledge of statistical reporting techniques to support decisions as well as record obtainment and retention protocols.

Experience with word processing programs and spreadsheet (or other related) data collection/analytical programs.

Knowledge of additional Federal and State regulations, as they pertain to 1915c HCBS Wavier services and human services systems.

Experience in meeting deadlines.

Experience with internal/external stakeholders.

Additional Considerations

Competitive candidates should meet these additional considerations:

Considerable experience preparing and presenting complex information to a diverse audience (stakeholders, leadership, other state agencies, etc).

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.

All applicants for employment must be authorized to work in the United States for any employer. DMAS participates in E-Verify to confirm the identity and employment eligibility of newly hired employees.

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 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 Assistance Services, an application and/or resume for employment must be submitted electronically through this website. Mailed, faxed, emailed, or hand-delivered applications/resumes will not be accepted. Consideration for an interview is based solely on the relevant information presented in the state application and/or resume submitted before the closing date.

Applications and/or resumes should include relevant work history which indicates your qualifications for this position.

The Department of Medical Assistance Services practices fair and equal employment opportunity to all employees and applicants in accordance with applicable laws and regulations. It is our policy to prohibit discrimination on the basis of race, sex, color, national origin, religion, sexual orientation, gender identity, age, veteran status, political affiliation, genetics, or disability in the recruitment, selection, and hiring of its workforce.

In support of the Commonwealth’s commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth's Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their AHP Letter (formerly called a Certificate of Disability) provided by the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Service-Connected Veterans may also apply via the AHP if they also provide an AHP Letter. To request an AHP Letter, use this link: https://www.dars.virginia.gov/drs/cpid/PWContact.aspx or call DARS at 800-552-5019, or DBVI at 800-622-2155

The Department of Medical Assistance Services is a V3 certified state agency that provides hiring preference to veterans and members of the reserves and/or National Guard in support of executive order 29, (2010). If you are a Veteran or Spouse of a Veteran or Active Military Member, DMAS encourages you to apply and respond accordingly on your state application.

Contact Information

Name: DMAS Talent Acquisition

Phone: 804-225-4407

Email: askhcdtalentacq@dmas.virginia.gov

In support of the Commonwealth’s commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their AHP Letter (formerly COD) provided by the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Service-Connected Veterans are encouraged to answer Veteran status questions and submit their disability documentation, if applicable, to DARS/DBVI to get their AHP Letter. Requesting an AHP Letter can be found at AHP Letter or by calling DARS at 800-552-5019.

Note: Applicants who received a Certificate of Disability from DARS or DBVI dated between April 1, 2022- February 29, 2024, can still use that COD as applicable documentation for the Alternative Hiring Process.