This is a full time position with dayshift hours and great benefits!
This position can work remotely in VA!
Job responsibilities:
Responsible for providing operational support of MLTSS clinical processes in collaboration with the Care Coordination team and the LTSS Authorization team.
Reviews reports, requests and documentation for information concerning LOC changes.
Contacts authorized screening entities statewide to obtain MLTSS screenings within expected timeframes.
Corresponds with DMAS to request screenings and to obtain regulatory guidance on the screening process and other processes that affect waiver eligibility.
Corresponds with Nursing/Hospice Facilities for LOC change information, member data updates and regulatory reporting.
Collaborates with LTSS Authorization team for members with CCC Plus waiver authorization requests.
Reviews MLTSS screenings for validity and authorization.
Determines member eligibility for LTSS waivers and completes charting.
Submits waivers to DMAS for eligible members. Notifies Analytics Department for follow-up to ensure accurate payment from DMAS.
Assists with corrections of LOC change forms and LOCERI assignments, and acts as a point of contact for access to DMAS portal.
Reviews, approves, processes and audits charts for DMAS 225s.
Provides education to Care Coordinators.
Handles the fax queue; attaches faxes in the charting system and creates notifications.
Other duties as assigned.
Job requirements:
Preferred: ALD - Associate's Level Degree
Required: Minimum of 2 years related working experience in a medical setting, preferably long-term care, home health, or MCO. Knowledge of Medicaid waiver services.
Experience working with low-income, disadvantaged, disabled, elderly, and vulnerable populations preferred.
Benefits: Sentara offers an attractive array of full-time benefits to include Medical, Dental, Vision, Paid Time Off, Sick, Tuition Reimbursement, a 401k/403B, 401a, Performance Plus Bonus, Career Advancement Opportunities, Work Perks, and more.
Sentara Healthcare offers employees comprehensive health care and retirement benefits designed with you and your family's well-being in mind. Our benefits packages are designed to change with you by meeting your needs now and anticipating what comes next. You have a variety of options for medical, dental and vision insurance, life insurance, disability and voluntary benefits as well as Paid Time Off in the form of sick time, vacation time and paid parental leave. Team Members have the opportunity to earn an annual flat amount Bonus payment if established system and employee eligibility criteria is met.
For applicants within Washington State, the following hiring range will be applied: $ 21.75 to $ 32.61/hour.
Headquartered in Virginia Beach, VA, Sentara Health Plans is the health insurance division of Sentara Healthcare, offering health plans through its subsidiaries.
Sentara Health Plans provide health insurance coverage to over 900,000 members through a full suite of commercial products including consumer-driven, employee-owned and employer-sponsored plans, individual and family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees.
With more than 30 years’ experience in the insurance business and 20 years’ experience serving Medicaid populations, we offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services – all to help our members improve their health. Wherever we serve our members, Optima Health stands out through our passion for health and service excellence.
Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.
Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!
To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-31371.
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Talroo – Health Plan
LTSS Waiver Authorization Coordinator, MLTSS, Medicaid, MCO, Health Plan, DMAS, Remote, Virginia, North Carolina, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington (state), West Virginia, Wisconsin, Wyoming
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