Provider Network Evaluator I – HCBS

GeneralGeneralFull TimeRemoteSeniorTeam 1,001-5,000Since 2012H1B SponsorCompany SiteLinkedIn

Location

North Carolina

Posted

4 hours ago

Salary

$25 - $32 / hour

Seniority

Senior

Bachelor Degree5 yrs expEnglish

Job Description

Provider Network Evaluator I – HCBS

Alliance Health

• Validate and Approve TBI, Innovation Waiver, 1915(i), and LTCS Sites and Services • Review and validate service site documentation for TBI, Innovation Waiver, 1915(i), and LTCS programs; confirm compliance with regulatory standards to authorize member access to new or existing service locations • Perform HCBS reviews as required and within the required timeframes • Review provider policies and procedures for compliance with CMS mandated HCBS standards • Review and manage HCBS portal to ensure portal entries are reviewed and accepted prior to service initiation and move in • Collaborate with other MCOs when a member is transferred into the Alliance catchment area or transferred out of the Alliance catchment area • Work with providers to ensure out of compliance findings are remedied either by providing technical assistance and/or through a plan of correction • Work with I/DD Care Coordination, Provider Network Development and agency providers to ensure sites are validated and in compliance • Remediate issues and concerns that are identified by the State with MIE surveys through documentation review, technical assistance with providers and other stakeholders, and collaboration with I/DD Care Coordinators • Provide reports and updates on outcomes of reviews of HCBS and the potential impact on consumers involved to the Provider Network Evaluator Supervisor and/or the Director of Network Evaluation • Review self-directed services (Employer of Record) on an annual basis as required • Maintain a current database of HCBS sites that require monitoring and review • Maintain a database of unlicensed AFL sites that require annual reviews

Job Requirements

  • A bachelor’s degree in a Human Service field (such as Psychology, Social Work, etc.)
  • At least five (5) years of progressive experience in the field of I/DD or TBI
  • Strong knowledge of I/DD and TBI services
  • Experience with Home Based and Community Services (HCBS) is highly desired
  • Must maintain a valid driver’s license and a good driving record.
  • Working knowledge of federal and state statutes, rules, definitions and regulations that govern MHDDSAS services
  • Knowledge of all disability areas including Mental Health, Developmental Disabilities and Substance Abuse
  • Extensive knowledge of I/DD and TBI services and requirements
  • Knowledge and understanding of the principles, concepts and Best Practices used in the treatment, habilitation and support of individuals with needs in any of the disability areas
  • High level of diplomacy and discretion
  • Strong mediation skills
  • Excellent team building skills
  • Effective communication skills
  • Microsoft Office skills

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, holiday, management leave
  • Dress flexibility

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