|
Commonwealth of Pennsylvania |
|
|
POSITION DESCRIPTION FOR JOB POSTING |
|
|
Position Number: 00068801 |
Description Activated On: 1/5/2026 1:45:44 PM |
Position Purpose: Describe the primary purpose of this position and how it contributes to the organization’s objectives. Example: Provides clerical and office support within the Division to ensure its operations are conducted efficiently and effectively. Review and evaluate clinical and fiscal records in accordance with established Field Operations review procedures to assess Nursing Facilities (NF) compliance (MDS, OBRA, Admissions, Financial) with all applicable Federal and State requirements. Reviews are performed on site at every certified Medicaid Nursing Facility statewide. |
|
Description of Duties: Describe in detail the duties and responsibilities assigned to this position. Descriptions should include the major end result of the task. Example: Types correspondence, reports, and other various documents from handwritten drafts for review and signature of the supervisor. Description of Duties: Describe in detail the duties and responsibilities assigned to this position. Descriptions should include the major end result of the task. Example: Types correspondence, reports, and other various documents from handwritten drafts for review and signature of the supervisor. - Evaluate and review medical, physical, rehabilitative, restorative and other care being provided to determine appropriateness. - Review, understand and relate pertinent Departmental, State and Federal policies, licensure requirements, and regulations to ensure compliance by Medical Assistance (MA)/OLTL providers. - Participate in the development of new and/or revision to existing medical assistance policies and regulations. - Coordinate and interact with other Agencies and Departments to ensure appropriate services for individuals using long-term living services. - Perform monitoring reviews in all Long-Term Living settings in order to determine that the provision and adequacy of medical, social, physical, rehabilitative and restorative care services are being provided in accordance with all regulations and licensure criteria. - Review Minimum Data Set (MDS) submitted to the MDS database for accuracy and documentation support in the clinical records. - Review PA Pre-Admission Screening Resident Review (PA-PASRR-ID) process to assure nursing facilities (NF) compliance with the Omnibus Budget Reconciliation Act (OBRA). - Perform evaluations of identified PASRR positive individuals residing in long term care facilities including submission of packet with recommendations to the appropriate Program Office (OMHSAS, ODP, ORC, or DMVA) for review. - Monitor appropriateness of NF admissions and determine need for continued stay by reviewing clinical records, evaluate discharge plans and interview staff and residents. - Perform financial reviews to identify recoveries to ensure adjustments are made for any inappropriate payments or billings in accordance with established regulations and guidelines. - Assist the Financial Representative with processing recoveries through reviewing supportive documentation and/or remittance advices submitted by the NF. - Coordinate NF reviews, including pre-review activities, entrance and exit conferences appropriate paperwork during the review and all post review activities. - Perform follow up reviews to ensure compliance with corrective action plans as submitted by the nursing facility. - Perform any specialized reviews and projects with MA/OLTL providers as necessary. - Monitor individuals who receive services in the Ventilator and Durable Medical Equipment Programs to ensure that they continue to receive services and that they are using their DME as approved by the Program. - Perform assessments for individuals in the Home and Community Based Waiver Programs (HCBS) as requested. - Assist with other PDA and OLTL projects as an assessor or monitor of services, as necessary. - Act as a resource for exchange of information through verbal and written communication with NF to enhance NF's awareness of applicable Federal and State regulations. - Provide technical assistance to NF staff as needed to achieve NF compliance with applicable Federal, State and Department requirements pertaining to the Field Operations review process (MDS, OBRA, Financial). - Process Facility Alert/Act 28 forms to notify appropriate agencies of any issues identified during reviews. - Participate in formal training programs. - Acquire knowledge and be proficient in the use of office equipment including laptop computer and relevant software. - Perform other related job duties. |
Decision Making: Describe the types of decisions made by the incumbent of this position and the types of decisions referred to others. Identify the problems or issues that can be resolved at the level of this position, versus those that must be referred to the supervisor. Example: In response to a customer inquiry, this work involves researching the status of an activity and preparing a formal response for the supervisor’s signature. - Compile and analyze information following the Field Operation review of the Nursing Facility. Prepare all relevant paperwork and reports to inform the NF of the findings. - Review and accept or reject the Corrective Action Plan submitted by the NF for appropriate intervention of problem areas. - Complete assessments on potential PASRR positive individuals and submit recommendations to Program Office. |
||||||||||||||||||||
Requirements Profile: Identify any specific experience or requirements, such as a licensure, registration, or certification, which may be necessary to perform the functions of the position. Position-specific requirements should be consistent with a Special Requirement or other criteria identified in the classification specification covering this position. Example: Experience using Java; Professional Engineer License Experience: Licenses, registrations, or certifications: 1. Registered Nurse Licenses, registrations, or certifications: 1. Registered Nurse 2. N/A 3. N/A 4. N/A 5. N/A 6. N/A |
||||||||||||||||||||
Essential Functions: Provide a list of essential functions for this position. Example: Transports boxes weighing up to 60 pounds.
|