Prior Authorization Analyst Jobs Near Me

The Ohio Department of Developmental Disabilities (DODD) mission is to partner with people and communities to support Ohioans with developmental disabilities and their families in realizing their version of a good life.

Ohio is the heart of opportunity, and we envision Ohio as the best place in the nation for people with developmental disabilities to thrive. Our core values reflect our focus on the experience of each person we support:

• Inclusion
• Partnership
• Respect

   The Division of Medicaid Development and Administration works with state agency personnel and stakeholders to develop policies related to Medicaid funded services        for people with developmental disabilities.

What You'll Do

Act as an RPS2 covering various areas of the Medicaid Unit to ensure that workflow is current.  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.  

Including but not limited to: 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.  Develops and write reports in accordance with office procedures. Performs records/documentation development/maintenance functions (e.g. develops, sends & receives email & phone communications from involved parties); uses the appropriate DODD applications (including, but not limited to, prior authorizations, state-funded behavior addons, and nursing task inventory processes.  

Collaborates 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 whom have assigned responsibility for the administration of Medicaid processes & procedures (e.g., reviewing & revising policies & procedures related Prior Authorization, nursing and Waiver, to inform policy analysis & development).

Monitors & evaluates systems activities of local Department of Job & Family Services (DJFS) case workers through Ohio Benefits System (OBS) and Medicaid Systems (e.g., new applications, Medicaid eligibility determinations, appeals, etc.)

Advises state & local staff on correct procedures to follow to assist applicants to obtain Medicaid eligibility, provides technical assistance & assists in problem solving between DJFS case workers or other systems. Implements program policy & procedures that impact waiver eligibility, and Nursing. Provides testimony at hearings, if necessary.

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 AND 12 months' experience as Rehabilitation Program Specialist 1, 69731. 

-Or in Ohio Department of Developmental Disabilities only, 4 years' experience in private or governmental agency responsible for habilitative &/or rehabilitative programs development in developmental disabilities (i.e., working with individuals with developmental disabilities) AND 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.
Job Skills: Counseling and Rehabilitation, Attention to detail, Critical thinking, Establishing relationships, Ethics and value, Problem solving, Time management