Provider Network Evaluator I – HCBS
Location
North Carolina
Posted
4 hours ago
Salary
$25 - $32 / hour
Seniority
Senior
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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