Waiver Services Specialist

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Job Description:

As a Waiver Services Specialist youll play a key role in connecting individuals with the support they need to thrive. Working under limited supervision youll assess funding needs for developmental disability services and determine eligibility for Medicaid Home and Community-Based Services (HCBS) Waivers. Your work will include conducting assessments reviewing documentation and records and making informed decisions for individuals who are aged meet Social Security disability criteria or have intellectual or developmental disabilities. Youll also participate in informal dispute resolution meetings or appeal hearings related to eligibility decisions. Every day your expertise will help ensure people receive the services that empower them to live with dignity and independence.

Job Duties:

• Review applications and medical documentation to determine eligibility for waiver services.

• Perform initial and renewal Level of Care (LOC) assessments with accuracy and attention to detail.

• Guide applicants families and providers through requirements and next steps with clarity and support.

• Participate in appeals or dispute hearings advocating with professionalism and empathy.

• Ensure accurate and timely documentation while efficiently managing multiple cases.

• Other duties as assigned.

Requirements / Qualifications:

Minimum Qualifications: Bachelors degree in: human services education or health/medical; long-term care gerontology rehabilitation health/disability case management or children with special health care needs OR any equivalent combination of education and experience will be considered on a year for year basis.

Preferred Qualifications:Experience in healthcare long-term care disability services or completing assessment. Familiarity with medical terminology and Medicaid waiver services.

Other:Valid drivers license and access to reliable transportation.

Knowledge Skills and Abilities (KSA)

• Strong knowledge of Medicaid Waiver programs Level of Care (LOC) criteria and services for individuals with disabilities older adults and those with special health care needs.

• Understanding of medical terminology healthcare systems and state/federal regulations related to eligibility and assessments.

• Skilled in reviewing documentation conducting assessments and making accurate timely eligibility decisions.

• Effective communication skills to explain complex information clearly and work with individuals families and service providers.

• Proficient in using systems like Excel Word and Outlook for documentation and data management.

• Ability to manage multiple cases in a fast-paced environment while maintaining attention to detail and meeting deadlines.

• Demonstrated empathy professionalism and discretion when working with vulnerable populations and handling sensitive information.

• Strong critical thinking and problem-solving skills to navigate complex cases and apply policy accurately.

• Team-oriented with the ability to work independently and adapt to changing policies and procedures.

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