Title: Quality Management Review Analyst

State Role Title: Health Care Compliance Spec II

Hiring Range: $57,299 - $75,854

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 a Quality Management Review Analyst. The selected competitive candidate will provide exceptional delivery of services to the agency’s Division of High Needs Support.
Job responsibilities will include, but are not limited to:
Quality Management Review (QMR) Analysts will work in the field to conduct on-site quality management reviews (QMR) to assure the health, safety, and welfare of individuals receiving Medicaid Long-Term Care Services through home and community based waiver programs.
QMR Analysts will spend three to four overnights a week for three to four weeks of a month completing on-site reviews.
Programs reviewed include and are not limited to: Family and Individual Supports Waiver, Building Independence Waiver, and Community Living Waiver through routine quality management reviews. (Based on the nature of the complaint we may make a referral to the proper agency in most cases.)
Staff will make decisions regarding health welfare & safety of waiver enrollees, document compliance, and verify services were rendered.
Staff provides training and/or technical assistance to providers and participate as subject matters experts in policy/procedure development.
As an employee of DMAS you are entitled to the many comprehensive benefits the Commonwealth has to offer. This includes health benefits, 12 paid holidays, paid leave, flexible work schedules, & retirement plans. For more specific details please visit https://www.dhrm.virginia.gov/employeebenefits.
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 of the Developmental Disabilities Waivers and person centered planning.
Considerable knowledge reviewing medical record and applying applicable regulations and generating letters reflecting the results of the reviews.
Knowledge of electronic health records; project management; standards of treatment and medical terminology.
Knowledge to analyze data and resolve problems; research and identify changes in program requirements and policies.
Knowledge in the use of personal computers, word processing and spreadsheet applications (Microsoft Suites).
Knowledge/Experience interpretation and application of federal, state laws/regulations.
Experience in meeting deadlines.
Experience with internal/external stakeholders.

Additional Considerations

This position does not have any additional considerations.

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 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.