Waiver Support Specialist

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

At Acentra Health, we embrace emerging technologies, including artificial intelligence and advanced analytics that can be utilized to improve processes, enhance decision-making, and drive better health outcomes. We value professionals who are curious about new technologies and motivated to use innovative tools to increase efficiency, quality, and impact in their roles.

Acentra Health is looking for a Program Review Analyst to join our growing team.

Job Summary:

The Waiver Support Specialist performs initial administrative and service-plan reviews for Indiana Medicaid Home- and Community-Based Services programs. This role reviews submitted service plans and supporting documentation to identify potential duplication, overlap, inconsistencies, missing information, and coordination issues among waiver services, State Plan services, and other Medicaid-funded supports.

The Specialist evaluates whether proposed services, units, frequency, and duration are appropriately supported by the information provided and consistent with the member's identified needs and service-plan goals. The Specialist prepares well-documented recommendations for State review and routes the cases requiring clinical expertise or additional clarification to the appropriate clinical reviewer or supervisor.

This position does not independently make clinical determinations or final authorization decisions. Recommendations are subject to clinical review, State policy, and final determination by the Indiana Family and Social Services Administration or other designated State authority.

Responsibilities:

• • Review HCBS waiver service plans and related documentation to support accurate, consistent, and timely recommendations to the State.
  • Evaluate proposed services in the context of the member's documented needs, functional limitations, person-centered goals, and available supports.
  • Identify potential duplication, overlap, gaps, inconsistencies, or coordination issues among waiver services, State Plan services, and other Medicaid-funded programs.
  • Prepare objective, well-supported recommendations regarding the appropriateness of requested services, including whether additional clinical or administrative review is needed.
  • Collaborate with leadership to resolve questions and support effective service-plan review.
  • Maintain accurate documentation and ensure review activities comply with Indiana Medicaid requirements, waiver policies, contractual standards, and organizational procedures.
  • Support quality assurance, audit, trend-analysis, training, and process-improvement activities related to HCBS service-plan review.
  • Maintain current knowledge of waiver programs, service definitions, applicable policies, and system processes as Indiana's HCBS programs evolve.
  • Protect member information and comply with HIPAA, privacy, security, and organizational policies.
  • Perform other related duties as assigned.

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.

Required Qualifications

• • Associate's degree in a related field with at least 5 years' relevant professional experience or a Bachelor's degree with 3 years' relevant professional experience
  • 2 years or more of experience in case management, service coordination, care coordination, waiver administration, Medicaid benefits administration, or a related healthcare or human-services environment.
  • Demonstrated ability to review service plans, assessments, clinical or functional documentation, and other records to identify member needs and service requirements.
  • Strong written and verbal communication skills, with the ability to prepare clear, objective, and well-supported recommendations.
  • Strong organizational skills, attention to detail, and the ability to manage multiple assignments within established timeframes.
  • Proficiency with Microsoft Office and the ability to learn electronic case-management and service-plan review systems.
  • Ability to protect confidential member information and comply with HIPAA and organizational privacy and security requirements.

  Preferred Qualifications and Experience

  • Experience working directly with Indiana Medicaid or Indiana HCBS waiver programs.
  • Experience as a waiver case manager, service coordinator, care coordinator, supports coordinator, Qualified Intellectual Disabilities Professional, or in a comparable role.
  • Experience supporting individuals with intellectual or developmental disabilities, traumatic brain injury, behavioral health needs, physical disabilities, or complex medical conditions.
  • Experience reviewing person-centered plans, functional assessments, treatment plans, prior authorizations, service authorizations, or related documentation.
  • Knowledge of Medicaid State Plan services, HCBS waiver service categories, service units, and coordination of benefits.
  • Experience identifying duplicate services, overlapping benefits, or opportunities to improve coordination across programs.

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Experience in Lieu of Degree

For non-clinical roles, or when not required by the contract specifically, the Company acknowledges that practical, hands-on experience can provide skills and competencies equivalent to formal education. As such, in cases where a Bachelor's degree may be required, the Company will accept a minimum of six (6) years of directly relevant professional experience in lieu of a degree. In instances where the candidate has an Associate's degree, the Company will accept a minimum of three (3) years of directly relevant professional experience in lieu of the Bachelor's degree.

Thank You!

We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!

We are committed to providing a secure and positive hiring experience. Depending on the role, interviews may be conducted virtually, in person, or through a combination of both. As part of our recruitment process, candidates may be asked to participate in identity verification measures to help ensure the integrity of the hiring process.

~ The Acentra Health Talent Acquisition Team

Visit us at https://careers.acentra.com/jobs

EEO AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

Compensation

The pay range for this position is listed below.

"Based on our compensation philosophy, an applicant's position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level."