Provider Network Operations Specialist (Full-time Remote, North Carolina Based)

Alliance Health•Fayetteville, NC

4d•$61,439 - $78,335•Remote

About The Position

The Network Operations Specialist supports the development and management of the Provider Network by managing scopes of work, providing technical assistance, and monitoring provider contracts. Incumbents also support operational activities related to special initiatives. This position is full-time remote. Selected candidate must reside in North Carolina and be willing to travel to one of the offices for business or onsite team meetings as needed. Occasional provider site visits may be required within local area.

Requirements

Bachelor’s degree in a Human Services field from an accredited college or university and three (3) years progressive post-degree experience in the field of Mental Health, Substance Use, Intellectual/Developmental Disabilities or Physical Health.
Master’s degree in Human Services from an accredited college or university with one (1) years post graduate experience in the field of Mental Health, Substance Use, Intellectual/Developmental Disabilities or Physical Health.
Knowledge of Alliance’s goals, targets, and outcomes in relation to the responsibilities of the Provider Network Operations department.
Knowledge of all disability areas including Mental Health, Substance Use and Developmental/Intellectual Disabilities
Knowledge and understanding of principles, concepts, and Best Practices used in the treatment, habilitation and support of individuals with needs in any of the disability areas
Knowledge and understanding of the different systems that impact Providers
Microsoft Office suite, including Excel
Proficient with database maintenance
Exceptional interpersonal skills
Highly effective Communication skills
Problem solving skills
Organizing skill
Conflict resolution skills
Effective public speaking and training skills
Strong mediation skills in order to facilitate collaboration and positive relationships
High Level of diplomacy and discretion to effectively negotiate and resolve issues independently
Ability to make prompt independent decisions based upon relevant facts
Ability to review and analyze data in an effort to evaluate program effectiveness, progress, problems, and system performance
Ability to work effectively with others internally and externally
Ability to effectively identify problems, and initiate solutions
Ability to take initiative and utilize critical thinking

Nice To Haves

Provider Networks experience preferred.

Responsibilities

Manage Provider Scopes of Work (SOW)
Ensure information in the Scopes of Work is up-to-date and accurate
Conduct Scope of Work reviews, both clinical and financial, in accordance with established procedures to ensure provider is meeting requirements and producing expected outcomes
Meet with Providers to review Scope of Work twice per year and ongoing if needed
Organize and lead interdepartmental meetings to ensure Scopes of Work are reviewed as needed
Ensure Scopes of Work get routed into contracts for the following fiscal year
Ensure assigned providers’ contracts are completed with applicable scopes of work each contract year
Provide technical assistance and customer service to network providers
Oversee the Provider Hub, including monitoring and sharing information
Provide education and technical assistance to Providers
Research and Troubleshoot Provider Issues
Provide more targeted communication with providers as directed and assigned
Ensure reporting requirements are completed as required
Review ongoing funding and financial information to make recommendations for future funding
Troubleshoot with provider on any funding issues and/or adherence to best practices
Ensure that Evidence Based and Best Practice services for members are in place as identified and are available for members. Maintain awareness of fidelity elements and adherence to those standards
Assist, guide and support providers in the development and maintenance of comprehensive, outcome focused services for members.
Ensure all applicable NCQA standards relating to Provider Network Development functions/responsibilities are followed as required
Collaborate with other departments, and external stakeholders
Collaborate with other departments and external Stakeholders
Provide support related to the Provider Network to other departments such as Care Management, Finance, Provider Network Evaluation
Represent Alliance, as directed and assigned, in Point of Contact calls with the State, longstanding provider collaboratives, local Provider Advisory Council (PAC) meetings, community crisis collaboratives, etc.
Assist in the development of the agenda and presenting as needed at the All Provider Meetings and Alliance Provider Advisory Council
Facilitate established provider collaboratives as assigned
Establish and maintain relationships and collaborations with relevant public, private, and provider agencies, in order to assure open communication, avoid misunderstanding and support solution focused atmosphere within the community
Monitor Provider Contracts
Make recommendations on the development and termination of provider contracts
Be knowledgeable of assigned provider contracts with agencies and organizations in conjunction with Alliance’s Finance and Contract departments
Analyze, review, and approve invoices in conjunction with contractual terms
Discuss rate changes, funding, and other changes that impact provider contracts with department management
Support operational activities related to special initiatives
Oversee Letters of Support, Home and Community Based Services (HCBS), Waiver Requests, and/or Transition to Community Living initiatives
Monitor spending and work across departments to revise funding caps
Revise and Maintain Scopes of Work