Provider Network Evaluator I – HCBS

Alliance Health

. Validate and approve TBI, Innovation Waiver, 1915(i), and LTCS sites and services .

Posted 10/27/2026full-timeMorrisville • North Carolina • United StatesMid-LevelSenior💰 $26 - $33 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates extensive knowledge of I/DD and TBI services, regulatory compliance, and HCBS standards while effectively collaborating with providers and stakeholders to ensure quality care and compliance. Proficient in data analysis and problem-solving to enhance program effectiveness and address compliance issues.

Highest-signal resume keywords

I/DD Services KnowledgeTBI Services KnowledgeHCBS Compliance ManagementNational Certified Investigator and Inspector Training (NCIT)Data Analysis and Evaluation

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Regulatory ComplianceService Site ValidationDocumentation ManagementQuality Improvement StandardsEmergency Decision-MakingProgram Effectiveness EvaluationMonitoring and ReportingTechnical AssistanceHealth and Safety ReviewRecords Management

Soft Skills

Effective CommunicationTeam BuildingMediation SkillsDiplomacy and DiscretionProblem-Solving

Tools & Technologies

HCBS PortalMicrosoft Office

Certifications & Qualifications

Bachelor's Degree in Human ServicesValid Driver's LicenseNational Certified Investigator and Inspector Training (NCIT)

Industry Keywords

Home Based and Community Services (HCBS)Mental HealthDevelopmental DisabilitiesSubstance AbuseNorth Carolina RegulationsMHDDSAS ServicesClinical Coverage Policy1915(i) WaiverUnlicensed Alternative to Family Living (AFL)I/DD Care Coordination

About the role

Key responsibilities & impact

Validate and approve TBI, Innovation Waiver, 1915(i), and LTCS sites and services
Maintain knowledge of HCBS Final Rule, HCBS procedures, 1915(i) Waiver, Clinical Coverage Policy, NC Administrative Code, records management and documentation requirements
Review and validate service site documentation and confirm compliance with regulatory standards
Perform HCBS reviews within required timeframes
Review provider policies and procedures for compliance with CMS-mandated HCBS standards
Manage the HCBS portal and ensure entries are reviewed and accepted before service initiation and move-in
Collaborate with other MCOs on member transfers into or out of the Alliance catchment area
Work with providers to remedy noncompliance through technical assistance and/or plans of correction
Work with I/DD Care Coordination, Provider Network Development and agency providers to ensure sites are validated and compliant
Remediate issues identified by the State through MIE surveys
Provide reports and review-outcome updates to the Provider Network Evaluator Supervisor and/or Director of Network Evaluation
Conduct annual and initial Unlicensed Alternative to Family Living site reviews, including health, safety and client-rights review
Immediately address health, safety and quality-of-care issues
Maintain and update service sites and member locations
Review self-directed services (Employer of Record) annually
Maintain EOR spreadsheet and monitoring folders
Assist with development and maintenance of HCBS, unlicensed AFL, IFDS, quality improvement, monitoring and site-validation standards and procedures
Maintain databases of HCBS and unlicensed AFL sites requiring monitoring
Track discrepancies and errors in State-required reports and reconcile them as needed
Track I/DD Care Coordination HCBS assessments/reviews and communicate discrepancies
Maintain knowledge of services, supports, regulations and requirements within North Carolina
Participate in investigations and focused reviews when quality-of-care or health-and-safety concerns arise
Travel between Alliance offices, review sites, member/provider/stakeholder locations, meetings, events and court hearings

Requirements

What you’ll need

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
Must maintain a valid driver’s license and a good driving record
The National Certified Investigator and Inspector Training (NCIT) is required; candidate must complete and pass the course within 6 months of hire and meet the 1-year employment requirement as a regulatory investigator/inspector
Experience with Home Based and Community Services (HCBS) is highly desired
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 treatment, habilitation and support principles, concepts and Best Practices
High level of diplomacy and discretion
Strong mediation skills
Excellent team building skills
Effective communication skills
Microsoft Office skills
Ability to identify/analyze administrative problems pertinent to the contract
Ability to make independent judgments, logical conclusions, recommendations and decisions
Ability to determine the appropriate course of action in an emergency or stressful situation
Ability to maintain confidentiality of consumer data and provider business practices
Ability to review and analyze data to evaluate program effectiveness, progress, problems and system performance
Ability to work effectively with others internally and externally

Benefits

Comp & perks

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