HCBS-Developmental Disabilities (DD) Waiver Enrollment & Appeals Specialist TERM LIMITED

HCBS-Developmental Disabilities (DD) Waiver Enrollment & Appeals Specialist Term Limited

The Policy and Operations Specialist serves as the Office of Community Living's recognized expert on HCBS Developmental Disabilities (HCBS-DD) waiver enrollment policy, Emergency Enrollment Request (EER) determinations, youth transitions, and HCBS/Community First Choice (CFC) appeals operations. This position independently interprets federal Medicaid regulations, state statutes, State Board rules, and waiver requirements to ensure consistent, equitable, and compliant statewide administration of enrollment and appeals processes.

The position provides strategic policy leadership and expert consultation to Department leadership, Case Management Agencies (CMAs), internal program teams, and external stakeholders regarding complex enrollment and appeals issues. As the Department's primary authority on EER determinations and appeals policy, this position establishes statewide policy interpretations, develops decision-making frameworks, identifies systemic program risks, and recommends policy and operational improvements that directly influence rulemaking, legislative analysis, waiver administration, and long-term Medicaid sustainability. Decisions and recommendations made by this position have significant statewide implications for federal compliance, budget management, program integrity, and equitable access to services.

Key Responsibilities

• Serve as the Department's primary expert and reviewer for Emergency Enrollment Requests (EERs) within the HCBS-DD waiver program.
• Develop and maintain statewide policy interpretations, decision frameworks, and operational guidance related to HCBS-DD waiver enrollment and emergency access to services.
• Apply federal regulations, state statutes, waiver requirements, and Department policy to determine eligibility for enrollment and EER approval.
• Ensure consistency, equity, and compliance in enrollment determinations across all Case Management Agencies (CMAs).
• Review, approve, deny, and communicate EER determinations and resolve disagreements regarding enrollment decisions.
• Identify policy gaps, determine when existing policy requires clarification or revision, and recommend changes to leadership.
• Provide policy guidance, technical assistance, and operational support to CMAs regarding enrollment processes, youth transitions, and waiver requirements.
• Analyze enrollment and EER data, identify trends, and prepare reports and recommendations to improve statewide processes and outcomes.
• Manage and coordinate HCBS waiver and Community First Choice (CFC) appeals activities across the Department and external stakeholders.
• Provide authoritative interpretation of appeals-related federal guidance, state statutes, State Board rules, and Department policies.
• Monitor appeal timelines and ensure compliance with regulatory requirements and established deadlines.
• Coordinate with CMAs, Department program staff, and the Office of Legal Services regarding appeals status, outcomes, and resolution strategies.
• Develop and maintain tracking systems for appeals and generate reports to identify trends, risks, and opportunities for improvement.
• Analyze appeal outcomes to identify systemic issues and recommend policy, operational, or training enhancements.
• Independently interpret complex federal and state requirements and develop policy recommendations that influence statewide enrollment and appeals practices.
• Advise Department leadership on programmatic impacts, compliance risks, operational challenges, and long-term sustainability strategies.
• Support Department rulemaking, legislative analysis, and policy development efforts related to HCBS waiver programs.
• Identify and evaluate systemic issues affecting program access, compliance, and operational effectiveness, and recommend corrective actions.
• Develop guidance, procedures, and training materials to support consistent statewide implementation of policy.
• Serve as the primary policy resource for CMAs, internal Department teams, advocacy organizations, and other external partners.
• Collaborate with stakeholders to clarify policy intent, resolve complex issues, and improve program operations.
• Represent the Department in discussions, negotiations, and workgroups involving enrollment policy, appeals operations, and HCBS waiver administration.
• Foster statewide consistency and alignment in policy implementation and operational practices.
• Ensure enrollment and appeals processes comply with federal waiver assurances, the 1915(c) waiver agreement, state requirements, and Department standards.
• Monitor statewide practices and identify compliance vulnerabilities, operational risks, and opportunities for process improvement.
• Exercise independent judgment on highly complex issues with significant statewide programmatic, fiscal, legal, and compliance implications.
• Provide recommendations that support equitable access to services, program integrity, and long-term Medicaid sustainability.

Residency Requirement:

This posting is only open to residents of the State of Colorado at the time of submitting your application.

Minimum Qualifications

Policy Advisor IV H1R3XX

There are two ways to qualify for this position:

Option 1:

Seven (7) total years of professional experience in developing and implementing tools and policies to manage a health care service utilization.

Option 2

Bachelor's degree from an accredited institution in Health Care Administration, Public Health, Public Administration, Health Services, or a related field AND

Three (3) total years of professional experience developing and implementing tools and policies to manage a health care service utilization.

Appropriate education will substitute for the required experience on a year-for-year basis. Relevant education will be calculated as the following:

• An associate's will count as two years of experience
• A bachelor's will count as four years of experience
• A master's degree will count for six years of experience
• A doctorate or juris doctorate degree will count for seven years of experience

Note: Per the Job Application Fairness Act, you may redact information that identifies your age, date of birth, or dates of attendance at or graduation from an educational institution on your transcripts.

Preferred qualifications:

• Prior state experience in interpreting and applying state and federal regulations.

DEFINITION OF PROFESSIONAL EXPERIENCE: Work that involves exercising discretion, analytical skill, judgment, personal accountability, and responsibility for creating, developing, integrating, applying, and sharing an organized body of knowledge that characteristically is uniquely acquired through an intense education or training regimen at a recognized college or university; equivalent to the curriculum requirements for a bachelor's or higher degree with major study in or pertinent to the specialized field; and continuously studied to explore, extend, and use additional discoveries, interpretations, and application and to improve data, materials, equipment, applications and methods.

CONDITIONS OF EMPLOYMENT

• All positions at HCPF are security sensitive positions and require that the individuals undergo a criminal record background check as a condition of employment.
• Employees who have been disciplinary terminated, resigned in lieu of disciplinary termination, or negotiated their termination from the State of Colorado must disclose this information on the application.
• This is a term-limited position with funding through June 30, 2028. Successful candidates will sign a Waiver of Retention Rights and normal personnel rules regarding retention will not apply. Additional information regarding term-limited positions can be found here.

APPEAL RIGHTS:

If you receive notice that you have been eliminated from consideration for this position, you may file an appeal with the State Personnel Board or request a review by the State Personnel Director.

An appeal or review must be submitted on the official appeal form, signed by you or your representative. This form must be delivered to the State Personnel Board by email (View email address on click.appcast.io), postmarked in US Mail or hand delivered (1525 Sherman Street, 4th Floor, Denver CO 80203), or faxed View phone number on click.appcast.io) within ten (10) calendar days from your receipt of notice or acknowledgement of the department's action.

For more information about the appeals process, the official appeal form, and how to deliver it to the State Personnel Board; go to spb.colorado.gov; contact the State Personnel Board for assistance at View phone number on click.appcast.io; or refer to 4 Colorado Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, at spb.colorado.gov under Rules.

How to Apply (PLEASE READ CAREFULLY)

Please note that ONLY your State of Colorado job application will be reviewed during the initial screening; if you submit a resume and cover letter, they will be reviewed in later stages of the selection process. Therefore, it is paramount that you clearly describe all your relevant experience on the application itself. Applications left blank or marked "SEE RESUME" will not be considered.