Provider Network Evaluator I – HCBS

🔥 9 minutes ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $25 - $32 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Alliance Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2012

⚕️ Healthcare Insurance

Healthcare Insurance

Alliance Health is a regional health plan serving residents of several North Carolina counties by administering Medicaid and state-funded behavioral health and specialty services. It operates Tailored Plan coverage and Medicaid Direct options that integrate physical health, pharmacy, behavioral health, intellectual/developmental disability (I/DD), and traumatic brain injury (TBI) services, provides 24/7 behavioral health crisis support, member and provider portals, community trainings and outreach, and coordinates care through provider networks and governance committees.

📋 Description

• 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

🎯 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