Substance Use Provider Network Manager - LP (Remote NC)

LOCATION: Remote - this is a home-based, virtual position that operates Monday-Friday from 8:30am-5:00pm EST. Candidates may live anywhere within Vaya's catchment area. Incumbent must maintain residency in North Carolina or within 40 miles of the NC border.

GENERAL STATEMENT OF JOB

The Substance Use Provider Network Manager - LP is responsible for maintaining ongoing, collaborative relationships with community stakeholders and providers to support the development and management of the provider networks while maintaining the highest level of customer service. The Substance Use Provider Network Manager - LP will drive the improvement of provider performance by analyzing and interpreting both quantitative and qualitative data to address and prioritize network needs. This role will specifically focus on the unique needs of providers providing Substance Use providers across all levels of care and funding sources.

Vaya's Provider Network is tasked with providing focus for epidemics that impact our communities. The Substance Use Provider Network Manager - LP is tasked with providing focused support and shall have a majority (but not limited to) caseload focused on the specific treatment. In times of requirement to focus on a specific epidemic the Substance Use Provider Network Manager - LP will serve as the internal and external resource that knows services available in the network, actively pursues, addresses and fills gaps in the focused epidemic treatment services. The employee will partner with internal work teams, often leading such project teams, to assure access to the assigned epidemic's treatment and recovery programs across the Vaya network. The employee ensures that engagement with contracted providers is consistent and in line with contract obligations. This position will be focused on funded initiatives focused on the epidemic. The key function of the employee during times Vaya is tasked with focusing on a specific epidemic is to ensure that there is coordination among the various streams of state and/or federal funding coming into the organization to address the targeted epidemic. This employee will serve as a fundamental team member in administering and coordinating the implementation of federal grants withing Vaya that focus on various aspects of the focused epidemic.

Note: This position requires access to and use of confidential healthcare information or protected health information (PHI) as described in laws addressing patient confidentiality, including, but not limited to, the federal HIPAA law, the Confidentiality of Alcohol and Substance Abuse Patient Records law, 42 CFR Part 2, and various state laws. As such, the individual filling this position shall be required to be trained regarding such laws and shall be required to observe those laws in his/her capacity as an employee of Vaya Health. The individual filling this position shall also sign a confidentiality statement as an employee of Vaya Health.

ESSENTIAL JOB FUNCTIONS

Provider Network Management:

• Collaborate with SU network providers to assure contracts are executed and providers receive necessary technical assistance
• Develop, direct, support, and oversee initiatives specific to focused epidemics as assigned to the business
• Facilitate provider education and training to increase provider familiarity, alignment and satisfaction with Vaya Health's (Vaya) systems, expectations, and strategies. Lead development of network training initiatives and manage coordination with external education vendors as assigned.
• Participate in development of provider operational manuals and educational materials that are tied directly to established clinical coverage policies as assigned
• Study and design innovative SU programs to create and enhance access to quality care
• Work independently and cross-departmentally to ensure that Vaya maintains accreditation standards (e.g. URAC, NCQA, etc.) and DHHS Waiver requirements related to its provider network
• Apply network configuration and incentive-based payment models as appropriate to improve quality services and efficiency
• Facilitate provider contract meetings with high impact providers to proactively address access or quality issues.
• Proactively triage provider complaints and ensure appropriate follow up in instances where work flows or infrastructure are not functioning properly
• Facilitate programs that positively impact markets of stakeholders and members
• Answer, log, track, and respond to all provider calls and emails received through the Vaya provider phone line or email address
• Establish relationships with provider agencies and Vaya Board members as needed to facilitate the goals of the network, meet member needs, and enhance relationships with Vaya
• Manage, oversee, and implement plans in times when Vaya is tasked with focusing on a specific epidemic
• Complete assigned elements of annual network development plan ensuring completion of assigned elements by date identified each calendar year and present information to internal and external stakeholders as assigned
• Update internal policies and procedures as assigned
• Provide expertise for stakeholders groups mandated by contract and as assigned

Provider Contracts:

• Function as the single point-of-contact for all on-going contractual and service issues as assigned and as needed by providers
• Provide support and coordination for the preparation of grant proposals, reports and presentations, including those for funders and stakeholders.
• Oversee, coordinate and monitor all grants received by Vaya related to specific epidemic initiatives. This includes, but is not limited to, developing and maintaining project management tools to track grant project/program funding and work plans, including fiscal and administrative reporting timelines and deliverables
• Ensure administrative tasks associated with grant accounting, contracts and budgets adhere to state and federal standards and requirements
• In alignment with Vaya's population health and quadruple aim objectives negotiate and re-negotiate provider organization contracts, including specialty provider organization contracts, in collaboration with legal team.
• Assist others to resolve highly complex or unusual business problems that affect major functions or disciplines

Data & Reporting:

• Create and review trend analyses and summaries for decision-making purposes. In times where Vaya is tasked with focusing on a specific epidemic this will include providing reports that describe the intent, deliverables and outcomes of each grant and assure that they are implemented per grant, state and federal requirements
• Collaborate in the development of project policies, protocols and procedures to ensure compliance with reporting timelines and deliverables.
• As assigned, liaison with disability specific Provider Advisory Council subcommittees on gaps analysis/network development plan and establish due dates for information sharing
• Participate in the development, implementation and coordination of federal grant evaluation and data collection protocols
• Complete assigned elements of gaps analysis ensuring completion of assigned elements by date identified each calendar year and present information to internal and external stakeholders
• Interface with Vaya network and department leaders to align provider development needs and projects
• Set targets and priorities, in order to meet specialty specific network needs
• Disseminate provider communication details to internal staff assuring consistency of information and talking points for provider communications
• Log and maintain provider Frequently Asked Questions (FAQ) to maintain a record of consistent responses to provider questions
• Work with Office of Communications to log and track Provider Communication content for historical reference
• Gather and update provider demographic data to ensure software databases are accurate
• Conduct and manage provider satisfaction activities

Other duties as assigned.

Note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Incumbent in this position will also be cross-trained to be able to perform the duties of the Substance Use Provider Network Manager (Bachelor's Level) and will be able to assist and/or provide coverage to complete time sensitive, required duties should there be a need.

KNOWLEDGE, SKILLS, & ABILITIES

• Expert knowledge on Substance Use addiction treatment with a concentration on Opioid related treatments and other focused epidemic treatments when presented
• Expert level of knowledge of Center for Medicare and Medicaid Services (CMS) & CMS reimbursement methodologies, Federal Block Grants, and State funding reimbursement methodologies
• Knowledge of the assessment and treatment of mental health, developmental disabilities, and substance use disorder, sometimes co-occurring
• High level of knowledge of Microsoft Office applications and adept at learning software applications - expert level preferred
• Highly motivated, team player, self-starter and able to work independently with little or no direction
• Ability to exercise discretion and make independent decisions without supervisory input on matters of significance
• Proficiency in analyzing, understanding, and communicating network needs
• Strong customer service skills paired with a positive demeanor - a "can do" attitude
• Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others, including but not limited to reimbursement policy standards
• Exceptional business acumen
• Ability to present to varied audiences on various disability topics
• Ability to manage multiple priorities in a fast-paced environment
• Prior demonstrated success in provider relations or relations with both large provider groups and/or ancillary providers
• Experience with multiple relations methodologies such as RVRBS, flat rates, case rates, and per diems and tiered rates based on the intensity of service helpful
• Proficiency in analyzing, understanding and communicating financial trends

EDUCATION & EXPERIENCE REQUIREMENTS

Master's degree in a Human Services field required. Must have

• 2-5 years relevant Substance Use treatment and/or recovery focused experience required.
• 5+ years experience working with Substance Use services or a related field working with Substance Use providers

Licensure/Certification Required:

Preferred Experience:

• Experience developing and writing contracts and utilizing financial modeling in making rate decisions preferred
• 2-5 years of experience in a provider relations-related role handling complex network providers in the health care industry with accountability for business results preferred.
• 5+ years of experience in a network management-related role handling complex network providers in the health care industry with accountability for business results preferred.
• Experience with capitation contracts and 5+ years of experience utilizing financial modeling in making rate decisions preferred
• 5+ years of experience developing and managing a medical cost and administrative budget preferred

PHYSICAL REQUIREMENTS

• Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading.
• Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists, and fingers.
• Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time.
• Mental concentration is required in all aspects of work.

RESIDENCY REQUIREMENT: The person in this position is required to reside in North Carolina or within 40 miles of the North Carolina border.

SALARY: Depending on qualifications & experience of candidate. This position is exempt and is not eligible for overtime compensation.

DEADLINE FOR APPLICATION: Open Until Filled

APPLY: Vaya Health accepts online applications in our Career Center, please visit https://www.vayahealth.com/about/careers/.

Vaya Health is an equal opportunity employer.