[Hiring] Waiver Support Specialist @Acentra Health, LLC

Role Description

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

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.

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.

Requirements

• 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.

Benefits

• Comprehensive health plans.
• Paid time off.
• Retirement savings.
• Corporate wellness.
• Educational assistance.
• Corporate discounts.
• And more.