Rehabilitation Program Specialist 2 (PN 20036245)

Ohio Department of Administrative Services • Columbus, OH

7h

About The Position

Will work with supervisor for assignments in all the areas within the division that include Prior Authorization (PA), Nursing Tasking Inventory (NTI), State Funded Behavioral Add-on (SFBAO) and perform all duties of the RPS2. Reviewing assessments and/request to make determinations related to requests for PA, NTI, and SFBAO; submitted by county boards of developmental disabilities (CBDDs) for initial & ongoing budget review of Medicaid Home & Community-Based Services (HCBS) Waivers. Prepares correspondence and hearing rights to send to individuals who are denied services or found to no longer meet necessary requirements for services. Prepares hearing summaries and supporting documentation for hearings to submit to the Bureau of State Hearings. Reviews assessments submitted by CBDDs & Develops, coordinates, monitors reviews & evaluates Medicaid Home and Community-based Services Waiver prior authorization process & procedures. Reviews documentation provided by the appropriate county board of developmental disabilities (CB/DD) to determine if approval criteria are met utilizing federal & state regulations. Coordinates with department consultants for programmatic support & assistance with questionable cases or for general consultation. Evaluates & makes recommendations of approval of prior authorization, state-funded behavior addons, and nursing waiver budgets when appropriate. Makes recommendations for action resulting from information gathered through review process & participates in implementation of such action. Conducts reviews in accordance with department’s polices & procedures; Develop and write reports in accordance with office procedures. Uses the appropriate DODD applications (including, but not limited to, prior authorizations, state-funded behavior add-ons, and nursing task inventory processes, Medicaid Service System. Collaborate with other department/division staff regarding relationship of prior authorization approval to Payment Authorization of Waiver Services (PAWS). Provides testimony at hearings, if necessary. Provides support to staff throughout the Department who have assigned responsibility for the administration of Medicaid processes & procedures. Completes professional correspondence, reports, & complex technical documents requiring the use of Medicaid terminology; proofreads work & makes all appropriate changes to ensure correspondence, reports & documents are appropriate & error-free. Maintains Home & Community Based Services (HCBS) waiver information & data on DODD applications, systems and electronic devices. Cross-references data on spreadsheets & other documents with information in file folders to ensure accuracy of electronically entered data. Distributes, receives, & compiles information as needed to meet Medicaid waiver requirements. Prepares & maintains electronic file folders for applications for DODD-administered HCBS waivers & all related correspondence sent to ODM & CMS. Establishes & maintains a filing system to ensure proposed due dates for daily operations and program implementation are met, follows-up & advises supervisor appropriately, if problems arise. Creates, retrieves & re-files (either paper or electronic) materials, manuals, correspondence & other documentation as requested by immediate supervisor. Complete quarterly reports to account for prior authorization requests, Nursing Authorization requests, State Funded Behavioral add on requests and Hearing determinations within the 10-day requirement to complete the quarterly report. Tracks, logs, and completes data reports and updates as needed after review by manager and Subject Matter Experts. Manually process on and off boarding the completion/processing of nursing requests. Complete weekly performance measures and year to date annually for all reviews by RPS2s and # requests from each County Board of DD to ensure timelines are met for business/operational/compliance needs pursuant to applicable OAC rule. Assists with and providing ongoing monitoring for state hearing requests for MDA and communication with state hearing liaison. Hearing docket updates goes out every Tuesday. Assist with completion, dissemination (mailing, email, and uploading) for Appeal Summary packets and/or letters for Prior Authorization, Level of Care, Preadmission Screening and Resident Review, (PASRR, Nursing hearing requests, other MDA unit’s summary as applicable and compliance request inquiries through BSH portal and or HATS and monitors the BSH mailbox. Responsible for updating two hearing logs with accurate data. Assists with providing links for hearing and providing hearing decisions to the appropriate MDA administration.

Requirements

• Graduate degree in a human service area (i.e., rehabilitation counseling, special education, guidance & counseling, psychology, social work, child & family community services) as required by an accredited college or university
• Or a graduate degree that leads to licensure as a licensed professional counselor by the Ohio Counselor & Social Worker Board
• Or completion of graduate degree in other related vocational rehabilitation areas (e.g., rehabilitation management/administration from an accredited college or university)
• Or completion of graduate field of study in human services area (i.e., same examples as cited previously) as required by accredited college or university; 12 mos. exp. as Rehabilitation Program Specialist 1, 69731
• Or in Ohio Department of Mental Health & Addiction Services only, licensed, certified, or registered clinical professional per OAC 5122-21-03 (E) Personnel Requirements (2)
• Or in Ohio Department of Developmental Disabilities only, 4 yrs. exp. in private or governmental agency responsible for habilitative &/or rehabilitative programs development in developmental disabilities (i.e., working with individuals with developmental disabilities); bachelor’s degree in professional human services field (e.g., psychology, education, anthropology) in accordance with provisions of 42 CFR 483.430(b)(5)(x) & interpretive guidelines issued by centers for Medicaid & Medicare services
• Counseling and Rehabilitation

Responsibilities

• Work with supervisor for assignments in all the areas within the division that include Prior Authorization (PA), Nursing Tasking Inventory (NTI), State Funded Behavioral Add-on (SFBAO) and perform all duties of the RPS2
• Reviewing assessments and/request to make determinations related to requests for PA, NTI, and SFBAO; submitted by county boards of developmental disabilities (CBDDs) for initial & ongoing budget review of Medicaid Home & Community-Based Services (HCBS) Waivers
• Prepares correspondence and hearing rights to send to individuals who are denied services or found to no longer meet necessary requirements for services
• Prepares hearing summaries and supporting documentation for hearings to submit to the Bureau of State Hearings
• Reviews assessments submitted by CBDDs & Develops, coordinates, monitors reviews & evaluates Medicaid Home and Community-based Services Waiver prior authorization process & procedures
• Reviews documentation provided by the appropriate county board of developmental disabilities (CB/DD) to determine if approval criteria are met utilizing federal & state regulations
• Coordinates with department consultants for programmatic support & assistance with questionable cases or for general consultation
• Evaluates & makes recommendations of approval of prior authorization, state-funded behavior addons, and nursing waiver budgets when appropriate
• Makes recommendations for action resulting from information gathered through review process & participates in implementation of such action
• Conducts reviews in accordance with department’s polices & procedures; Develop and write reports in accordance with office procedures
• Uses the appropriate DODD applications (including, but not limited to, prior authorizations, state-funded behavior add-ons, and nursing task inventory processes, Medicaid Service System
• Collaborate with other department/division staff regarding relationship of prior authorization approval to Payment Authorization of Waiver Services (PAWS)
• Provides testimony at hearings, if necessary
• Provides support to staff throughout the Department who have assigned responsibility for the administration of Medicaid processes & procedures
• Completes professional correspondence, reports, & complex technical documents requiring the use of Medicaid terminology; proofreads work & makes all appropriate changes to ensure correspondence, reports & documents are appropriate & error-free
• Maintains Home & Community Based Services (HCBS) waiver information & data on DODD applications, systems and electronic devices
• Cross-references data on spreadsheets & other documents with information in file folders to ensure accuracy of electronically entered data
• Distributes, receives, & compiles information as needed to meet Medicaid waiver requirements
• Prepares & maintains electronic file folders for applications for DODD-administered HCBS waivers & all related correspondence sent to ODM & CMS
• Establishes & maintains a filing system to ensure proposed due dates for daily operations and program implementation are met, follows-up & advises supervisor appropriately, if problems arise
• Creates, retrieves & re-files (either paper or electronic) materials, manuals, correspondence & other documentation as requested by immediate supervisor
• Complete quarterly reports to account for prior authorization requests, Nursing Authorization requests, State Funded Behavioral add on requests and Hearing determinations within the 10-day requirement to complete the quarterly report
• Tracks, logs, and completes data reports and updates as needed after review by manager and Subject Matter Experts
• Manually process on and off boarding the completion/processing of nursing requests
• Complete weekly performance measures and year to date annually for all reviews by RPS2s and # requests from each County Board of DD to ensure timelines are met for business/operational/compliance needs pursuant to applicable OAC rule
• Assists with and providing ongoing monitoring for state hearing requests for MDA and communication with state hearing liaison
• Assist with completion, dissemination (mailing, email, and uploading) for Appeal Summary packets and/or letters for Prior Authorization, Level of Care, Preadmission Screening and Resident Review, (PASRR, Nursing hearing requests, other MDA unit’s summary as applicable and compliance request inquiries through BSH portal and or HATS and monitors the BSH mailbox
• Responsible for updating two hearing logs with accurate data
• Assists with providing links for hearing and providing hearing decisions to the appropriate MDA administration

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level