Substance Use Provider Network Manager

6 days ago

Asheville, North Carolina, United States Vaya Health Full time
Job Summary

The Substance Use Provider Network Manager will be 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. This role will drive the improvement of provider performance by analyzing and interpreting both quantitative and qualitative data to address and prioritize network needs. The Substance Use Provider Network Manager will specifically focus on the unique needs of providers providing Substance Use services across all levels of care and funding sources.

Key Responsibilities

• 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 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

Requirements

• 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
• 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.

Apply
Vaya Health accepts online applications in our Career Center, please visit

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