Substance Use Provider Network Manager (Remote - NC)

LOCATION:  Remote – this is a home-based, virtual position that operates within the hours of 8:30am-5:00pm EST.  Incumbent must live in North Carolina or within 40 miles of the NC border.   This position will require travel as needed.

GENERAL STATEMENT OF JOB

The Substance Use Provider Network Contract Manager 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 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.

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
• Facilitate provider education and training to increase provider familiarity, alignment and satisfaction with Vaya Health’s (Vaya) systems, expectations, and strategies
• 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
• Develop and maintain Provider Services “Quick Links” on Vaya Employee Resource Network (VERN) for quick identification and follow up to provider issues

Provider Contracts:

• Function as the single point-of-contact for all on-going contractual and service issues as needed by providers
• In alignment with Vaya’s population health and quadruple aim objectives negotiate and re-negotiate provider organization contracts in collaboration with legal team.
• Manage and track Out of Network Agreements (OON), Enrollment Forms, and Letters of Support for providers to apply for facility licensure received or facilitated with providers
• 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 
• 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.

KNOWLEDGE OF JOB

• Expert level of knowledge of Center for Medicare and Medicaid Services (CMS), Federal Block Grant, 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 

Bachelor’s degree required. Master’s degree preferred. Must have 5+ years of experience working with Substance Use services or a related field working with Substance Use providers.

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.

Preferred Licensure/Certification:

• License or license eligible in NC preferred but not required- Preferred license categories are LCSW, LCAS, and/or LCMHC.

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: This person must reside in North Carolina or within 40 miles of the NC 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.