Provider Network Evaluator -HCBS; Remote, Mecklenburg County, North Carolina

Provider Network Evaluator I-HCBS (Full-time Remote, Mecklenburg County, North Carolina Based) role at Alliance Health

Full-time remote position that requires travel to conduct on-site reviews and monitoring. The selected candidate must reside in North Carolina.

Provider Network Evaluator I (PNE I) is a QP level professional within the Provider Network Evaluation Department. The department ensures that providers properly deliver services to Alliance members and addresses any out-of‑compliance findings in a timely manner. The PNE I‑HCBS position will be assigned to the Home and Community Based Services (HCBS) team, responsible for reviewing Unlicensed Alternatives to Family Living placements and member self‑directed services in accordance with CCP8P, Attachment H, and HCBS final rule requirements.

• 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.
• Perform HCBS reviews within required time frames.
• Review provider policies and procedures for compliance with CMS‑mandated HCBS standards.
• Review and manage the HCBS portal to ensure entries are reviewed and accepted prior to service initiation and move‑in.
• Collaborate with other MCOs when members transfer into or out of the Alliance catchment area.
• Work with providers to remediate out‑of‑compliance findings through technical assistance or a plan of correction.
• Coordinate with I/DD Care Coordination, Provider Network Development, and agency providers to ensure sites are validated and in compliance.
• Remediate issues identified by the State with MIE surveys through documentation review, technical assistance, and collaboration with I/DD Care Coordinators.
• Provide reports and updates on HCBS review outcomes to the Provider Network Evaluator Supervisor or Director of Network Evaluation.
• Review and monitor Individual and Family Directed Services.
• Assist with the development and maintenance of departmental policies, procedures, and standards for HCBS, unlicensed AFL sites, IFDS, quality improvement, and service delivery evaluation.
• Provide monitoring information for inclusion in the provider database.
• Maintain knowledge of current services and supports available within the catchment area and in North Carolina.
• Participate in investigations and focused reviews when concerns about quality of care or health and safety arise.
• Travel between Alliance offices, attend meetings on behalf of Alliance, and participate in Alliance‑sponsored events; travel to review sites, meet with members, providers, stakeholders, and attend court hearings.

• Bachelor’s degree in a Human Services field (e.g., Psychology, Social Work) and at least five (5) years of progressive experience in I/DD or TBI services.
• Strong knowledge of I/DD and TBI services; experience with Home Based and Community Services (HCBS) highly desired.
• Valid driver’s license with good driving record.
• Working knowledge of federal and state statutes, rules, definitions, and regulations governing 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, and of best practices used in treatment, habilitation, and support.
• Diplomacy, discretion, mediation, team building, and communication skills.
• Proficiency with Microsoft Office.
• Analytical and problem‑solving abilities; independent judgment and decision‑making.
• Emergency response skills, confidentiality, and data analysis for program evaluation.
• Ability to work effectively with internal and external stakeholders.

$25.75 – $32.83 per hour, with exact compensation based on education, experience, market data, and internal equity.

• 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 flexibility