What are the responsibilities and job description for the 01003 PROVIDER AND MEDICAL CASE MANAGER position at Virginia Dept of Medical Asst Services?
Come as you are | Become who you want to be | That is our promise. Acknowledging the National history of systemic inequality and inequity, The Department of Medical Assistance Services (DMAS) continues to take a stand for social justice. DMAS remains committed to creating a more diverse, inclusive and equitable environment in Virginia by fostering excellence internally and externally in providing services to Medicaid Members and the Commonwealth. We are driven by a core commitment to diversity, equity and inclusivity. DMAS promotes a working environment where persons from all backgrounds and experiences are welcome, safe, and respected. The Department of Medical Assistance Services is working to improve the health and well-being of Virginians through access to high quality health care coverage. DMAS is seeking talented individuals who can align their experience with the mission of the agency and its’ core values – service, collaboration, trust, problem solving and adaptability.
Ven como eres | Conviértete en quien quieres ser | Ésta es NUESTRA promesa.
Reconociendo la historia nacional de desigualdad e inequidad sistémica, DMAS continúa defendiendo la justicia social. DMAS mantiene su compromiso de crear un entorno más diverso, inclusivo, y equitativo en Virginia fomentando la excelencia interna y externa en la prestación de servicios a los Miembros de Medicaid y al estado de Virginia. Nos impulsa un compromiso fundamental con la diversidad, la equidad y la inclusión. DMAS promueve un ambiente de trabajo donde las personas de todos los orígenes y experiencias son bienvenidas, están seguras y son respetadas.
The Department of Medical Assistance Services (DMAS) is currently seeking a Provider and Medical Case Manager within the Appeals Division. The incumbent will motivate and manage an interdisciplinary team of attorneys, appeals specialists, and administrative support assistants of the Appeals Division to process and adjudicate provider and client medical appeals. The manager will direct the activities of the Provider and Medical Cases Team, while providing hands-on support to manage the team’s workload and quality output. They will occasionally serve as a hearing officer to review and adjudicate client medical appeals and as needed, serve as an informal appeals agent to review and adjudicate informal provider appeals. They will ensure team members are trained and continuously growing in their skills, support the sustainment of a culture of teamwork and high expectations for employees and work collaboratively with other leaders in the Appeals Division to continuously improve workflow processes.
The Department of Medical Assistance Services (DMAS) is currently seeking a Provider and Medical Case Manager within the Appeals Division. The incumbent will motivate and manage an interdisciplinary team of attorneys, appeals specialists, and administrative support assistants of the Appeals Division to process and adjudicate provider and client medical appeals. The manager will direct the activities of the Provider and Medical Cases Team, while providing hands-on support to manage the team’s workload and quality output. They will occasionally serve as a hearing officer to review and adjudicate client medical appeals and as needed, serve as an informal appeals agent to review and adjudicate informal provider appeals. They will ensure team members are trained and continuously growing in their skills, support the sustainment of a culture of teamwork and high expectations for employees and work collaboratively with other leaders in the Appeals Division to continuously improve workflow processes.
The Provider and Medical Case Manager will provide excellent customer service, treat everyone who interacts with the Division with respect and dignity; ensure every appellant receives full due process; support a collaborative and positive work environment and produce a quality work product. This position reports directly to the Appeals Division’s General Operations Manager.
Minimum Qualifications
Qualified candidates, at minimum, must have:
- Demonstrated ability to lead a high-performing interdisciplinary team in daily operations, through coaching and guidance.
- Strong problem-solving skills in managing people, processes, and quality outputs.
- Ability to build and maintain strong working relationships with peers and collaborate in executing business operations.
- A demonstrated ability to communicate effectively verbally and in writing.
- The ability to use independent judgment to exercise a broad range of decision-making authority.
- The ability to interpret/apply/analyze complex laws, regulations, policies, or case law.
- The ability to demonstrate excellence in legal analysis and legal writing skills, preferably in drafting appeal decisions.
- Comprehensive knowledge of using electronic software to manage a caseload and perform legal research.
- Comprehensive knowledge of the law and legal system, preferably administrative law and appeals procedures.
- Considerable skill in the use of technology including MS Office or comparable productivity tools, such as – MS Word, MS Excel, MS PowerPoint, MS Visio.
- Graduation from an accredited law school and licensed to practice law by the Virginia State Bar.
Preferred Qualifications
The Preferred candidate will have:
- Professional experience in business and administrative management, administrative law, or the health care appeal processes, strong preference.
Special Requirements
This position is expected to work both remotely and/or in the office as driven by business needs. The ability to work remotely is required.
Special Instructions to Applicants
If you wish to apply for a job with the 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. Qualified individuals with disabilities are encouraged to apply.
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.
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. Qualified individuals with disabilities are encouraged to apply.
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.
Name
DMAS Talent Acquisition
Phone
Fax
Email
askhcdtalentacq@dmas.virginia.gov
Address
600 E. Broad Street
Richmond, VA 23219
Richmond, VA 23219
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