Provider Network Evaluator I – HCBS

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Validate and authorize TBI, Innovation Waiver, 1915(i), and LTCS Sites and Services.

• Examine and verify service site documentation for TBI, Innovation Waiver, 1915(i), and LTCS programs; ensure compliance with regulatory standards to facilitate member access to new or existing service locations.

• Conduct HCBS reviews as necessary and within the specified timeframes.

• Assess provider policies and procedures for adherence to CMS mandated HCBS standards.

• Oversee and manage the HCBS portal to confirm that entries are reviewed and accepted prior to service initiation and member move-in.

• Collaborate with other MCOs when a member is transferred into or out of the Alliance catchment area.

• Partner with providers to address non-compliance findings by offering technical assistance and/or developing a plan of correction.

• Work alongside I/DD Care Coordination, Provider Network Development, and agency providers to validate sites and ensure compliance.

• Address issues and concerns raised by the State through MIE surveys by performing documentation reviews, providing technical guidance to providers and stakeholders, and collaborating with I/DD Care Coordinators.

• Generate reports and updates on the outcomes of HCBS reviews and their potential impact on consumers to the Provider Network Evaluator Supervisor and/or the Director of Network Evaluation.

• Conduct annual reviews of self-directed services (Employer of Record) as required.

• Maintain an up-to-date database of HCBS sites that are subject to monitoring and review.

• Keep a record of unlicensed AFL sites that require annual evaluations.

⛳️ Requirements

• A bachelor's degree in a Human Services discipline (such as Psychology, Social Work, etc.).

• A minimum of five (5) years of progressive experience in the I/DD or TBI field.

• In-depth knowledge of I/DD and TBI services.

• Experience with Home Based and Community Services (HCBS) is strongly preferred.

• Must possess a valid driver's license and maintain an excellent driving record.

• Familiarity with federal and state statutes, rules, definitions, and regulations governing MHDDSAS services.

• Understanding of all disability areas, including Mental Health, Developmental Disabilities, and Substance Abuse.

• Comprehensive knowledge of I/DD and TBI services and their requirements.

• Awareness and understanding of principles, concepts, and Best Practices in the treatment, habilitation, and support of individuals with needs across all disability areas.

• High level of diplomacy and discretion.

• Strong mediation abilities.

• Exceptional team-building capabilities.

• Proficient communication skills.

• Competency in Microsoft Office applications.

🏝️ Benefits

• Medical, Dental, Vision, Life, Long Term Disability.

• Generous retirement savings plan.

• Flexible work schedules, including hybrid/remote options.

• Paid time off, including vacation, sick leave, holidays, and management leave.

• Dress code flexibility.