Waiver & Quality Coordinator

Northern Michigan Regional Entity•Gaylord, MI

9d•Hybrid

About The Position

Manages the day-to-day operations of the Northern Michigan Regional Entity’s (NMRE) regional Waiver programs, including oversight of enrollment, disenrollment, utilization, and participant activity status reviews. Serves as a liaison among the Prepaid Inpatient Health Plan (PIHP), Community Mental Health Services Programs (CMHSPs), and the Michigan Department of Health and Human Services (MDHHS). Facilitates regional capacity building and competency development related to Waiver programs.

Requirements

Behavioral health experience is required.
Bachelor’s degree in an applied area of social work, counseling, or nursing from an accredited college or university.
Corresponding state of Michigan licensure is required.
Maintains access to a reliable phone capable of receiving calls and messages.

Nice To Haves

Master’s degree preferred.
Lived experiences with behavioral health are valued.

Responsibilities

Reviews clinical documentation and applies professional judgment to evaluate waiver eligibility, continued enrollment eligibility, and compliance with waiver requirements.
Processes waiver enrollments/disenrollments in the State’s Waiver Support Application (WSA) system.
Acts as the link between CMHSPs, MDHHS, and NMRE on all waiver matters.
Interprets and communicates waiver regulations, clinical requirements, and operational standards.
Develops and delivers technical assistance, training, and corrective guidance to providers and regional partners, including documentation requirements, WSA system, utilization, and reports.
Conducts regular on-site monitoring visits, audits, and provider reviews throughout the region to evaluate compliance with waiver requirements, service delivery standards, documentation expectations, and quality outcomes.
Leads and participates in meetings and communications related to waiver requirements, including workgroups and committees.
Monitors Performance Metrics, such as HEDIS measures, and offers technical assistance to providers.
Assists in Risk Event trending and reporting.
Maintains effective customer relations with individuals served, referral sources, and stakeholders.
Communicates with providers and beneficiaries in a culturally and linguistically appropriate manner.
Performs other duties as assigned to meet the ongoing needs of the agency.
Responds to common inquiries and concerns from consumers, regulatory agencies, affiliates, and community members in a professional and timely manner.
Defines problems, collects and analyzes data, establishes facts, identifies trends, and draws valid conclusions.
Supports and promotes a recovery-based, person-centered, and culturally competent philosophy of service delivery.
Participates in team projects, workgroups, and committees as appropriate.
Adheres to all NMRE policies, procedures, and ethical standards.
Demonstrates commitment to NMRE's mission, vision, and values.
Reports any potential violations of the False Claims Act and any reportable occurrences as defined in the Compliance Plan.
Complies with HIPAA regulations and maintains the confidentiality and security of all protected information.
Maintains a positive attitude toward work assignments and fosters professional relationships with colleagues.
Promotes and contributes to a positive and supportive work environment.
Provides exceptional customer service in all interactions with internal and external stakeholders.
Maintains access to a reliable phone capable of receiving calls and messages.
Supervises, motivates, coaches, and develops direct reports, as applicable.
Maintains satisfactory job performance and meets established productivity and quality standards.
Communicates effectively, both verbally and in writing.
Reports to work on time and maintains regular attendance.
Travels as required to fulfill the responsibilities of the position.
Works in the office and/or remotely as required by the position and supervisor. Work location arrangements are subject to change based on organizational and operational needs.