Rates Specialist Jobs (NOW HIRING)

Location: Remote – must live in or near Rowan, Alamance, or Guilford County, North Carolina. The person in this position must maintain residency in North Carolina or within 40 miles of the North Carolina border. This position requires travel.

The primary purpose of this position is to assure the State's Diversion Referral and Screening (DRS) project is implemented successfully to increase the probability of "direct" diversions for the Transitions to Community Living (TCL) for those members at risk for entry into Adult Care Homes (ACH). The DRS project will allow Local Management Entities/Managed Care Organizations (LME/MCOs) to interact with individuals at risk for entry into ACHs earlier on in the admission/discharge process. This position is responsible for providing screenings and case management to individuals referred in the DRS process.

As part of the team, this position will screen members, make appropriate referrals, provide member education, and divert members from ACHs when possible. This position will promote an efficient, clinically sound, and person-centered approach to supporting individuals through this process. Contact with community stakeholders is significant and the Diversion Specialist is responsible for ensuring a high level of quality in customer service, including strong collaborative relationships with providers and key stakeholders (e.g., hospitals, DSS, ACHs, behavioral health and physical health providers, Tenancy Support providers, internal departments, and natural supports).

This is a mobile position with work done in a variety of locations. The Diversion Specialist spends a considerable amount of time in the field and completes required documentation/paperwork at an office location or in the employee's home (as applicable).

Diversion Screenings

• Functions as an independent screener to make the determination of whether an individual has SMI/SPMI; are eligible for Medicaid or state-funded services and are offered services whether they move into the community or reside in an ACH.
• Refers to other specialists for timely assessment as clinically indicated
• Ensures all State mandated tasks related to member disposition are completed within benchmark timeframes
• Gathers supporting documentation for initiatives upon request by Supervisor or other Vaya Health staff (with Supervisor approval).
• Ensures timely and thorough documentation of all efforts, both individual-specific and programmatically, as requested by Supervisor, and other TCL Team members.
• Possess knowledge of the needs of individuals with a mental illness, and substance use/addiction disorders and can effectively work with all individuals with respect on a level that they can understand and relate to

Managed Care Treatment Planning Care Coordination

• Enters and maintains data in the State's RSVP system and TCLD system as applicable
• Ensures Community Integration Plans (CIP) are developed for members based on State guidelines
• Provides education and information to TCL eligible individuals of all the available alternatives to entry into an ACH during the screening process.
• Develops and produces clear documentation that each individual's informed choice drove their decision to live in the setting of their choosing, especially if they choose to transition into an ACH.
• Refer all TCL eligible individuals who choose to be admitted to an ACH, for In-Reach.
• Convenes key providers and others in a collaborative approach to address needs of the individual and ensure appropriate treatment planning and evaluation
• Promotes person-centered practices, including use of person-centered language and person-centered tools in planning
• Identifies gaps in services and intervenes to ensure that the individual receives appropriate care
• Focuses on achieving positive outcomes for individuals, regardless of disposition status, including reduction in high-risk events and inappropriate service utilization
• Ensures that services for the individual are coordinated across the Vaya Health system and with other systems, including primary care
• Provides support and direction for the individual and his/her treatment team to ensure quality service and community integration
• Educates others about various housing options/resources and how to access them

Collaboration

• Partners with individuals/families, providers and community stakeholders, as applicable, to create solutions to issues/concerns, barriers to progress, etc.
• Works in partnership with other Vaya Health departments to address identified needs and opportunities to improve member outcomes

Knowledge, Skills and Abilities

• High level of diplomacy and discretion is required to effectively negotiate and resolve issues with minimal assistance
• Exceptional interpersonal skills and highly effective communication ability in both written and oral form
• Problem solving, negotiation and conflict resolution skills are essential to balance the needs of both internal and external customers
• Skilled at shifting between macro and micro level planning, maintaining both the big picture and seeing that the details are covered
• Considerable knowledge of the MH/SU/DD service array provided through the network of providers with additional knowledge in Medicaid B and C waivers, and NC DMA Clinical Coverage policies is essential
• Must be detail oriented, able to organize multiple tasks and priorities, and to effectively manage projects from start to finish
• Ability to change the focus of activities, when needed, to meet changing priorities
• Proficiency in Microsoft Office products (such as Word, Excel, Outlook, etc.) is required.
• Excellent written and verbal communication skills.
• Schedule Integrity combined with commitment to adhere to established deadlines.

Work is performed with considerable independence, with most work performed in the community and away from the office. Employee is familiar with values and goals of TCL and Care Coordination and minimal daily instruction is required. Formal supervision is scheduled monthly on an ongoing basis and informal supervision occurs as needed.

This is a mobile based position which primarily occurs during normal business hours. Employee is required to have and maintain high speed internet access (with a minimum download speed of 10Mb/s) in home residence as a condition of employment. The expense for installation and monthly maintenance of this internet access will be the responsibility of the employee. Driving is an essential function of the position. Travel within the community is required and after-hours meeting attendance should be expected upon occasion. Vaya Health reserves the right to call upon this employee during non-business hours as needed to meet the demands of the position.

Knowledge of Job

• Ability to multitask and prioritize to manage multiple projects on tight timelines
• Ability to take ownership of projects from planning through execution
• Strong attention to detail and superior organizational skills
• Ability to understand the strategic direction and goals of the department and support appropriate processes to facilitate achievement of business objectives
• Comfort with adapting and adjusting to multiple demands, shifting priorities, ambiguity, and rapid change
• Well-developed capabilities in problem solving and crafting efficient processes
• A result and success-oriented mentality, conveying a sense of urgency and driving issues to closure
• An ability to initiate and build relationships with people in an open, friendly, and accepting manner
• An innate drive to innovate and optimize the use of available resources
• An ability to be a responsible self-starter
• Proficiency with Microsoft Office proficiency, to include Excel, data analysis, and secondary research
• Knowledge of and experience with managing an operations system

Education & Experience Requirements

Bachelor's degree in Psychology, Social Work, Counseling or similar field required. At least two (2) years of post-bachelor degree progressive experience providing similar services to the populations served (MH/SU/IDD).

Mental/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: The person in this position is required to reside in North Carolina or within 40 miles of the North Carolina border

Salary: Depending on