Provider Network Evaluator I-HCBS (Full-time Remote, Wake, Cumberland or Harnett County, North Carolina Based)

The Provider Network Evaluator I (PNE I) is a QP level professional that works as part of the Provider Network Evaluation Department. The department has the responsibility for ensuring that providers are properly delivering services to Alliance members and their families and ensures any out of compliance findings are addressed in a timely manner.

The PNE I position will be assigned to the Home and Community Based Services (HCBS) team. This team is responsible for conducting reviews of Unlicensed Alternatives to Family Living placements for Alliance members and reviews of member self-directed services (Employee of Record) as described in CCP8P, Attachment H. The PNE I will also be involved in ensuring that HCBS final rule requirements are followed, to include ensuring validation of agency self-assessments and that member surveys are remediated when follow up is required.

This position is full-time remote. Selected candidate must reside in North Carolina. Onsite travel is required to conduct reviews and monitoring. 

Responsibilities & Duties

Ensure that TBI, Innovation waiver, 1915i, and LTCS (Long Term Care Supports) sites/services are valid to permit members to receive services from a new service location and/or maintain services at an existing site

• Perform HCBS reviews and intensive on-site 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 remedies 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 and monitor Individual and Family Directed Services

• Review self-directed services (Employer of Record) on an annual basis as required 
• Provide …