LTSS Waiver Authorization Coordinator- Remote in VA

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.

• 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