Title: Service Authorization Contract Analyst
State Role Title: Prog Admin Specialist II
Hiring Range: $74,263 - $88,580
Pay Band: 5
Agency: Dept of Med Assistance Svcs
Location: Dept of Medical Asst Services
Agency Website: www.dmas.virginia.gov
Recruitment Type: General Public - G
Job Duties
The Department of Medical Assistance Services (DMAS) is excited to offer a competitive opportunity to serve as the Service Authorization Contract Analyst in the Program Operations Division.
Job responsibilities will include, but are not limited to:
This position is responsible for providing support to the service authorization (Srv Auth) contract monitoring process.
Works with a team of contract monitors and service authorization specialists in determining the service authorization contractor's compliance with all aspects of the service authorization contract.
Special emphasis on assisting with review of determinations for Traditional Services, Non-Traditional Services and some Behavioral Health Services, including appeal summaries as needed, and problem resolution from providers, members, constituents and the service authorization contractor.
This position will also work with the Behavioral Health service authorization services.
The service authorization contract is a large and multi-faceted contract that includes IM systems and clinical decision making.
This business needs for this position have in office requirements to include but are not limited to attending in-person meetings and training.
Located in beautiful Central Virginia, the Richmond area puts you just 2 hours from the Blue Ridge Mountains, Virginia Beach and Washington DC. To learn more about the Richmond, VA area visit: https://www.virginia.org/
The Department of Medical Assistance Services (DMAS) is working to improve the health and well-being of Virginians through access to high quality health care coverage.
DMAS wants talented individuals who can align their experience with the mission of the agency and its core values – service, collaboration, trust, problem solving and adaptability.
At the Department of Medical Assistance Services (DMAS) we encourage and promote that you Come as you are | Become who you want to be | That is our promise.
Minimum Qualifications
Competitive candidates will meet these minimum qualifications:
Considerable knowledge/experience of health care needs of individuals from birth to end stage with various diagnoses and medical health issues.
Considerable knowledge/experience in medical standards of practice as they relate to medical diagnoses of members.
Considerable knowledge/experience monitoring, auditing, and working with contractors, to include analyzing data to resolve problems.
Considerable knowledge/experience using nationally recognized clinical guidelines for program development/planning/implementation.
Considerable knowledge/experience in using Microsoft Products, including Word, Excel, etc. and the use of databases.
Knowledge/Experience with interpretation and application of federal, state laws/regulations.
Experience in meeting deadlines.
Experience with internal/external stakeholders.
Additional Considerations
Competitive candidates should meet these additional considerations:
Knowledge of medical necessity guidelines/criteria.
Knowledge of UM (utilization management) processes.
Special Instructions
You will be provided a confirmation of receipt when your application and/or résumé is submitted successfully. Please refer to “Your Application” in your account to check the status of your application for this position.
The Virginia Department of Medical Assistance Services (DMAS) does not offer employment-based Sponsorship. Selected candidates will have their work authorization completed using the E‐Verify Program.
The Department of Medical Assistance Services (DMAS) is an Executive Branch agency that will adhere to all policies and procedures, to include the Commonwealth’s Department of Human Resource Management Policy 1.61 Teleworking. This position could be expected to work in the office as driven by business needs.
Telework arrangements are a privilege and may be rescinded at any time based on performance and/or business need. The agency reserves the right to modify or terminate a telework arrangement, provided that reasonable notice is given to the employee.
This position requires a fingerprint based Criminal History Background Check, Education Checks if applicable, Work History Verification with references.
If you wish to apply for a job with 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.
In support of the Commonwealth’s commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth's Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their AHP Letter (formerly called a Certificate of Disability) provided by the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Service-Connected Veterans may also apply via the AHP if they also provide an AHP Letter. To request an AHP Letter, use this link: https://www.dars.virginia.gov/drs/cpid/PWContact.aspx or call DARS at 800-552-5019, or DBVI at 800-622-2155
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.
Contact Information
Name: DMAS Talent Acquisition
Phone: 804 - 225 - 4407
Email: askhcdtalentacq@dmas.virginia.gov
In support of the Commonwealth’s commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their AHP Letter (formerly COD) provided by the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Service-Connected Veterans are encouraged to answer Veteran status questions and submit their disability documentation, if applicable, to DARS/DBVI to get their AHP Letter. Requesting an AHP Letter can be found at AHP Letter or by calling DARS at 800-552-5019.
Note: Applicants who received a Certificate of Disability from DARS or DBVI dated between April 1, 2022- February 29, 2024, can still use that COD as applicable documentation for the Alternative Hiring Process.
