Waiver Contract Manager (Remote NC)

Vaya Health

10d•Remote

About The Position

The Waiver Contract Manager serves as the Contract Manager for Vaya Health’s (Vaya’s) contracts with the NC Department of Health and Human Services (the “Department”). This position is the designated point of contact with the Department and the primary liaison with Department staff. This position is responsible for driving implementation of, and continued compliance with all pertinent regulatory and contractual requirements applicable to Vaya’s managed care operations.

Requirements

Excellent oral and written communication skills and interpersonal skills, including active listening skills.
Strong interpersonal skills; ability to interact with all levels of leadership and management.
Demonstrated ability to build consensus and effect change.
Ability to assist in projects, motivate and influence others, and move toward a common vision or goal.
Ability to think creatively and strategically and work in a constantly evolving environment.
Must be proactive in identifying potential concerns with follow-up to bring resolution.
Strong analytical and problem-solving skills; demonstrated critical thinking and decision-making ability.
Strong organizational and research skills with proven attention to detail.
Demonstrated good judgment and ability to manage competing priorities.
Intermediate to advanced proficiency with Microsoft Office suite (Excel (pivot tables, graphs, charts), Word, Power Point).
Highly motivated, team player, self-starter and able to work independently with little or no direction. Permitted to work from home as needed with supervisory approval.
Familiarity with approaches and strategies for evaluating organizational constructs.
Resourceful with the ability to quickly achieve a basic working knowledge of the operations of each internal department.
Excellent grasp of the federal and state laws, rules, regulations, standards, guidelines and policies which govern the practices of Vaya and the overall service delivery system, including a working knowledge of basic privacy, security and confidentiality requirements applicable to a health plan.
Sound understanding of North Carolina Medicaid Managed Care.
Bachelor's degree in Business or health and human services related field required
Minimum seven years’ health-care related management experience (or comparable experience with a State Medicaid agency or State mental health agency) and at least two years’ experience in risk management, accountability, compliance, or quality management activities.
The person in this position is required to reside in North Carolina or within 40 miles of the North Carolina border.

Nice To Haves

Master’s preferred.
Certified in Healthcare Compliance (CHC) preferred.

Responsibilities

Serves as primary liaison with the NC Department of Health and Human Services (the “Department”) on all contractual and regulatory matters, including but not limited to issues surrounding the State’s 1115 Waiver, the 1915(i) SPA, and 1915(c) Waivers.
Attends and participates in regular and ad hoc committee meetings with Department staff across programmatic and technical areas, takes careful and detailed notes of such meetings, tracks action items, and reports out to Vaya SMEs and leadership on emerging issues and areas of concern as they relate to Vaya’s contract performance and the Department’s oversight and monitoring.
Proactively alerts the Area Director and Chief Executive Officer and General Counsel & Chief Compliance Officer of emerging risks relating to Vaya’s contractual performance or relationships with NCDHHS staff.
Develops and maintains excellent working relationships with Department officials and collaborates with waiver contract managers at other NC managed care organizations to develop common positions and promote LME/MCO interests.
Monitors and records all communications to/from the Department through the Waiver Contract mailbox. Timely distributes communication bulletins, proposed contract amendments, allocation letters, and other regulatory materials received from the Department to SMEs and responsible staff. Maintains the internal SharePoint folders where NCDHHS regulatory materials are stored and tracked.
Timely responds to inquiries and data requests from Department officials and provides guidance to Vaya staff on Waiver Contract requirements. Collaborates with the VP of Public Affairs as needed to respond to legislative inquiries.
Acts as primary owner and utilizer of the Department’s PHP Contract Data Utility (PCDU) system, ensuring timely uploads of deliverables as well as timely distributions of downloaded information. Works with the Performance Reporting Director to ensure all contractual reports are submitted timely through the PCDU.
Provides oversight of internal monitoring of and responding to tickets entered in the Department’s Service Now ticketing system, including supervision of the Ticketing Specialist.
Monitors the regulatory environment and works with the Legal Department to assess and communicate the impact of new and changing laws, rules, regulations, and Department contract requirements on the organization to ensure Vaya meets business objectives and External Quality Review requirements.
Supports the External Review Director with all external reviews as needed.
Participates in the development, implementation and maintenance of regulatory processes at an organization- wide level with a primary emphasis on compliance with Waiver Contract requirements, including but not limited to the annual External Quality Review.
Supports the Regulatory Compliance Team with the development, implementation and revisions of Vaya Standard Operating Procedures in order to improve efficiencies, ensures compliance with regulatory requirements, and develops a culture that fosters departmental self-determination of business and operational issues.
Serves on internal Vaya committees and workgroups and partners with other departments to ensure alignment of regulatory strategy and plans with organizational objectives.
Other duties as assigned.