Sentara Health Plans is recruiting a LTSS Waiver Authorization Coordinator!

Status: Full-Time, permanent position (40 hours)

Standard working hours: 8 am to 5 pm EST, M-F

Location: 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.

  View Orignal JOB on: partimejobs.net

• Handles the fax queue; attaches faxes in the charting system and creates notifications.

• Other duties as assigned.

Education:

• ALD - Associate's Level Degree preferred

Certification/Licensure:

• None required

Experience:

• Minimum of 2 years related working experience in a medical setting, preferably long-term care, home health, or MCO REQUIRED

• Medicaid experience REQUIRED

• Knowledge of Medicaid waiver services REQUIRED

• Experience working with low-income, disadvantaged, disabled, elderly, and vulnerable populations preferred.

Preferred qualifications:

• ALD - Associate's Level Degree preferred

Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees.

Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals.

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.

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-77219

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Talroo – Health Plan

LTSS Waiver Authorization Coordinator, MLTSS, Medicaid, MCO, Health Plan, DMAS, Remote, Virginia, VA, Long term care, home health