Waiver Quality Assurance Specialist
About The Position
Are you passionate about quality, systems improvement, and making sure programs truly deliver on their promise? We’re looking for a detail-oriented, collaborative, and motivated Waiver Quality Assurance Specialist to play a key role in strengthening program integrity and supporting exceptional outcomes for individuals served through our Medicaid Waiver Programs. In this role, you’ll perform specialized and technical work to implement and maintain a comprehensive Quality Management Plan, blending quality assurance and quality improvement activities. You’ll partner closely with Waiver Leadership to support staff development, and help ensure compliance, accuracy, and excellence across all waiver operations
Requirements
- Licensed Registered Nurse in the state of Kentucky or a Bachelor’s degree in a human services field.
- Must be in good standing with the appropriate credentialing or licensing board (if applicable).
- Three to five years of experience working in Medicaid Waiver Programs.
- Demonstrated knowledge of quality management principles and practices.
- Strong understanding of waiver programs, procedures, and agency policies
- Broad knowledge of special needs populations, community resources, and service organizations
- Excellent verbal and written communication skills
- Strong organizational skills and attention to detail
- Ability to work effectively with individuals who may have physical or intellectual limitations
- Collaborative mindset with confidence in leadership and decision-making
Nice To Haves
- Supervisory and/or leadership experience preferred.
Responsibilities
- Assist in the development, maintenance, and continuous improvement of the program’s Quality Management Plan.
- Conduct internal chart and quality reviews, including follow-up to ensure documentation is accurate, complete, and compliant.
- Review work for timeliness, completeness, and appropriateness, and initiate corrective actions when needed.
- Manage and submit required reports to state agencies and other oversight entities.
- Assist with policy development to support compliance and program effectiveness.
- Collaborating with the Waiver Team on staff development, training, recruitment, and hiring
- Communicate with providers regarding service delivery, maintenance, and issue resolution, serving as a client advocate when needed.
- Participate in case conferences with clients, caregivers, providers, coworkers, and leadership as requested.
- Attend and complete ongoing training required in alignment with DAIL and GRADD standards.
- Provide oversight and support for the team including process management, training, and reconciliation of monthly billing as needed
- Serve as the lead for all Waiver Program monitoring activities, ensuring all monitoring components are completed and maintaining communication with staff and monitoring agencies.
- Participate in agency functions such as committees, workgroups, and special projects as requested.
- Provide coverage for other Waiver Leadership as needed.
- Perform other duties or projects as assigned to support program goals.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
