Substance Use Provider Network Manager - LP (Remote NC)

Vaya Health • NC

121d

About The Position

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.

Requirements

• Master’s degree in a Human Services field required
• 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
• Valid licensure required. Acceptable licenses include LCSW, LCMHC, LCMHCS, LPA, HSP-PA, LCAS, or LMFT

Nice To Haves

• 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

Responsibilities

• 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 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 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
• 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
• Ensure administrative tasks associated with grant accounting, contracts and budgets adhere to state and federal standards and requirements
• Negotiate and re-negotiate provider organization contracts in collaboration with legal team
• Assist others to resolve highly complex or unusual business problems that affect major functions or disciplines
• Create and review trend analyses and summaries for decision-making purposes
• Collaborate in the development of project policies, protocols and procedures to ensure compliance with reporting timelines and deliverables
• 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

Benefits

• Salary depending on qualifications & experience
• Exempt position, not eligible for overtime compensation

What This Job Offers

• Job Type: Full-time
• Education Level: Master's degree