Waiver Specialist

Southwest Michigan Behavioral Health•Portage, MI

1d•Hybrid

About The Position

As part of the Prepaid Inpatient Health Plan (PIHP) benefits management system, the Waiver Specialist provides administrative and programmatic oversight of assigned federal Home and Community Based Services (HCBS) waivers and Medicaid specialty services, including Habilitation Supports (HSW), Serious Emotional Disturbances (SED), the Children's Waiver Program (CWP), and 1915(i). The role helps ensure compliance with Michigan Department of Health and Human Services (MDHHS) and PIHP requirements. The Waiver Specialist monitors enrollment, utilization, service access, documentation timeliness, and provider capacity; tracks waiver slots and prepares reports; and serves as a liaison between MDHHS and Community Mental Health Service Providers (CMHSPs). The role also provides administrative training and technical assistance to providers and CMHSPs, guides administrative and procedural corrective actions, and refers clinical performance or quality-of-care matters to the Clinical Quality Specialist. The position may assist with drafting and reviewing policies and protocols. The position is based in an office or home environment and may require travel to service locations, CMHSPs, or conferences.

Requirements

Bachelor's degree in social work, psychology, organizational psychology, healthcare administration, or a human services field.
Strong organizational skills and attention to detail, with the ability to track and report data accurately.
Ability to manage multiple projects and meet deadlines.
Strong oral and written communication and interpersonal skills.
Ability to work well in teams and independently.
Willingness and ability to travel to all service locations.

Nice To Haves

Experience with Medicaid waiver programs, HCBS services, or Intellectual/Developmental Disabilities and/or Autism populations.
Working knowledge of Michigan Medicaid Specialty Behavioral Health Services.
Life experience with diverse racial, ethnic, and cultural backgrounds, including behavioral health issues.

Responsibilities

Provide administrative oversight and coordination of assigned HCBS waivers and Medicaid specialty services to support federal, state, contractual, and PIHP compliance.
Monitor quality and provide oversight of Long-Term Services and Supports (LTSS) and HCBS waivers.
Assist with PIHP oversight, including stratifying cases for waiver slot selection.
Serve as liaison between MDHHS and CMHSPs regarding regional and state needs and requirements.
Monitor service utilization, documentation timeliness, service access, and provider capacity.
Track waiver enrollment, utilization, and slot or capacity availability, and prepare and submit accurate, timely reports to MDHHS and internal leadership.
Guide providers and CMHSPs on administrative and procedural corrective actions; refer clinical performance or quality-of-care matters to the Clinical Quality Specialist.
Provide administrative training, follow-up, and technical assistance to providers and CMHSPs.
Identify programmatic or administrative concerns and notify Senior Leadership and oversight committees.
Stay current with and comply with applicable federal and state guidelines and accreditation standards.
May assist in drafting and reviewing policy and protocol.