Job Specification Details

Administration, management, supervisory and Quality oversight of program development, implementation and evaluation. Regulation and licensure of state and federal certified health care facilities. Duties include policy administration; to include State and Federal Regulations, development of management and clinical systems, and fiscal oversight including management of budget, grants and contracts. Duties performed include extensive coordination and collaboration with internal and external partners requiring professional judgment, critical thinking, excellent communication skills, utilization of evidence-based practice, in-depth knowledge of federal and state regulations, and quality assurance skills. Duties include supervision and support of professional nursing staff, technical and non-nursing staff.

May administer the licensing and certification program for a variety of health and long-term care providers. Determines compliance with state and federal regulations and applies enforcement action as required. Negotiates with facility officials on action plans and timetables to achieve compliance. May recommend revocation, suspension of nonrenewal of license.

May implement State and Federal Rules into daily practice and procedures and identify trends to inform policy.

Provides leadership regarding program priorities, community needs, emerging population trends and nursing and family support staff competencies.

Analyzes desired population outcomes, national, state, regional and agency priorities and data trends to inform quality program management.

Initiates and maintains collaborative relationships among a variety of state and community organizations across multiple sectors related to health promotion, prevention and intervention strategies for staff and families.

May collaborate with other department and state units including Adult Protective Services, Medicaid Fraud Unit, Office of Public Regulation, Pharmacy, Clinical, Quality, Program Integrity, Vermont Chronic Care initiative and Substance abuse to make reports and address barriers and gaps and to assure integration of clinical operations with other initiatives

Assists with proposed or necessary reviews of proposed legislation or regulatory issues pertinent to program areas and in preparing budgets requests to include representing the Department in payment reimbursement systems.

May lead a team of professional and clerical staff with the primary focus on prior authorization of services for Vermont Medicaid beneficiaries to include recommending clinical improvement tools and coaching on clinical priorities, strategies for improving efficiencies and turnaround times for data entry and case reviews.

Oversees the quality component of the work by managing the Inter-Rater Reliability Program and develops, facilitates, coordinates and performs various quality assurance and quality improvement duties.

 Applies current Vermont Medicaid rules, regulations, policies and procedures, in the clinical reviews and coordination of such health care services.

Consults with the COU Director and/or Medical Director as appropriate for solutions to complex clinical issues/determinations.

Performs related duties as required.

Duties are performed in office and community settings as appropriate for which private means of transportation must be available. Some overtime and weekend work may be required. Some resistance or objection to standards may be anticipated requiring tact and diplomacy to achieve proper action.

Working knowledge of public health laws and regulations.

Expert knowledge of Federal and State Regulations.

May require expert knowledge of licensing and certification requirements applicable to health care and residential care facilities.

Working knowledge of State and Federal Rules.

Working knowledge of federal/state funding and requirements.

Ability to interpret and apply complex rules and regulations to specific case situations.

Ability to utilized evidence based practice.

Ability to effect clinical improvement efforts with a diverse set of stakeholders.

Ability to prepare detailed policy recommendations and implement practical and attainable solutions.

Considerable knowledge of case/disease management.

Considerable knowledge of the organization and service delivery systems of healthcare providers.

May require considerable knowledge and understanding of the case management and disease management.

May require considerable knowledge of medical procedures and equipment.

Considerable knowledge of the organization and service delivery systems of healthcare providers.

Considerable knowledge of other health care disciplines, which are involved in comprehensive patient care.

Considerable knowledge of human services resources.

Considerable knowledge of systems thinking.

Considerable knowledge of word processing software and Windows environment.
Ability to prepare detailed policy recommendations and implement practical and attainable solutions.

Ability to make accurate and professional patient care decisions.

Ability to work effectively with diverse set of public and private partners to facilitate clinical improvement efforts.
Ability to prepare accurate written and oral reports.
Ability to communicate effectively, both orally and in writing.
Excellent ability to establish and maintain effective working relationships.
Ability to deal with the stress of beneficiary and provider pressure and time constraints.

Supervisory ability to motivate teams and inspire excellence.

Possession of (or eligible for) licensure as a Registered Nurse (RN) in Vermont OR eligible to practice in teh state of Vermont via a multi-state license AND six (6) years or more of professional nursing experience.

NOTE: Must maintain Vermont or multi-state licensure as a Registered Nurse as a condition of employment.

Master of Science in Nursing (MSN).

Candidates must pass any level of background investigation applicable to the position. In accordance with applicable hiring standards, fingerprint supported criminal record checks, adult and child abuse registry checks, the Office of Inspector General exclusion database, and motor vehicle driving record checks, as appropriate to the positon under recruitment, will be conducted on candidates, with the exception of those who are current classified state employees seeking transfer, promotion, or demotion into a classified position or are persons exercising re-employment (RIF) rights.