Level of Care Review Quality Analyst (FFS)

Title: Level of Care Review Quality Analyst (FFS)

State Role Title: Health Care Compliance Spec II

Hiring Range: $25.00 - $33.00

Pay Band: UG

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 Level of Care Review Quality Analyst (FFS) in the Office of Community Living Division.

Job responsibilities will include, but are not limited to:

Responsible for the face-to-face assessment of the Level of Care Review (LOCERI) process for our Fee For-Service (FFS) members.

This includes health assessment, data collection, data entry, and communications with providers.

The incumbent will be responsible for the completion of the LOCERI and entry into CRMS.

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.

The incumbent will participate in the Appeals Process defending their assessment-based decisions in the DMAS appeal process.

The incumbent will participate in ensuring quality of care initiatives for members residing in long term care facilities are met. This position will apply rules, regulations, and laws in administration of waiver programs.

Must be a licensed LPN or RN in the Commonwealth of Virginia or have a bachelor's degree in a Health & Human Services field per Federal CMS requirements.

This is a field-based position that is remote and will require work travel regularly to the following areas of focus: NOVA counties of Culpepper, Page, Rappahannock, Warren, Shenandoah, Fauquier, Winchester, Frederick, Clarke, Loudoun, Prince William, Manassas, Manassas Park, Fairfax, Fairfax City, Alexandria, Arlington, or Falls Church.

The business needs for this position have limited in office requirements to include but are not limited to attending meetings and training.

The position you are applying for is an Hourly/Wage position. Hourly (wage) employees may not work more than an average of 29 hours a week and cannot exceed 1500 hours during their employment year. This position does not include health insurance, retirement or leave. 

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:

Must be a licensed LPN or RN in the Commonwealth of Virginia or have a bachelor's degree in a Health & Human Services field per Federal CMS requirements. (Please upload degree and/or LPN/RN license information into application).

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

Considerable experience of performing health-based assessments.

Considerable knowledge of the Level of Care Review Instrument (LOCERI) process.

Considerable knowledge and work-related experience with Microsoft Office.

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.

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

Considerable knowledge of CCC Plus Waiver and requirements.

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 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.