Provider Network Evaluator I – HCBS

Alliance Health

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

Posted 10/13/2026full-timeCharlotte • 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 service delivery.

Highest-signal resume keywords

Bachelor's Degree In Human ServicesNational Certified Investigator And Inspector Training (NCIT)Experience With Home Based And Community Services (HCBS)Strong Knowledge Of I/DD And TBI ServicesEffective Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Regulatory ComplianceService-Site Documentation ReviewData AnalysisProgram Effectiveness EvaluationTechnical AssistanceQuality ImprovementMonitoringSite-ValidationMIE Survey PoliciesAdministrative Problem Identification

Soft Skills

High Level Of DiplomacyStrong Mediation SkillsExcellent Team Building SkillsAbility To Make Independent JudgmentsAbility To Maintain Confidentiality

Tools & Technologies

Microsoft OfficeHCBS Portal

Certifications & Qualifications

Valid Driver's LicenseNational Certified Investigator And Inspector Training (NCIT)

Industry Keywords

HCBS Final RuleI/DD ServicesTBI ServicesMHDDSAS ServicesMental HealthDevelopmental DisabilitiesSubstance AbuseBest Practices In TreatmentHabilitation And SupportAdministrative Code

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, operating procedures, waivers, clinical coverage policies, administrative code, and documentation requirements
Review and validate service-site documentation and confirm regulatory compliance
Conduct HCBS reviews within required timeframes
Review provider policies and procedures for compliance with CMS-mandated HCBS standards
Manage HCBS portal entries before service initiation and move-in
Collaborate with other MCOs on member transfers
Help providers remedy findings through technical assistance and plans of correction
Work with care coordination, provider network development, and agency providers to validate compliant sites
Remediate issues identified through MIE surveys
Provide review outcome reports and updates to the Provider Network Evaluator Supervisor and/or Director of Network Evaluation
Conduct annual and initial Unlicensed Alternative to Family Living site reviews
Address member health, safety, and quality-of-care issues
Maintain service-site, member-location, EOR spreadsheet, monitoring folders, and provider databases
Review self-directed services annually and provide technical assistance
Assist with HCBS, IFDS, quality improvement, monitoring, site-validation, and MIE survey policies and procedures
Track discrepancies in state reports and reconcile records
Maintain knowledge of services and supports available in North Carolina
Participate in investigations and focused reviews when needed
Travel between offices, review sites, meetings, member/provider locations, stakeholder meetings, court hearings, and Alliance-sponsored events

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; 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 principles, concepts and Best Practices used in treatment, habilitation and support
High level of diplomacy and discretion
Strong mediation skills
Excellent team building skills
Effective communication skills
Microsoft Office skills
Ability to identify and analyze administrative problems pertinent to the contract
Ability to make independent judgments, logical conclusions, recommendations and decisions
Ability to determine appropriate action in emergency or stressful situations
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