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IDD Network Development Director

Vaya Health
Asheville, NC
  • Posted: over a month ago
  • Full-Time
Job Description
LOCATION: Remote but applicant should reside in North Carolina or within 40 miles of the North Carolina state border.


GENERAL STATEMENT OF JOB:

The IDD Network Development Director is responsible for the development, implementation, oversight, and performance of administrative work directly related to the management of the Vaya network of providers that make up the Intellectual and Developmental Disabilities (IDD) continuum services and supports. This role will work directly with IDD service providers to expand, develop, and implement services to support individuals with IDD and assure timely access to care.

This role exercises discretion and independent judgment across mental health, developmental disabilities, and substance use disorder (MH/DD/SAS) disciplines to conduct analysis of the provider network and implement network management strategies to ensure timely and quality access to services across the Vaya region. This is accomplished through the Network Access Plan and implemented through a comprehensive network development plan. The employee serves as an internal and external resource that knows services available in the network, actively pursues, addresses, and fills gaps in services per the network development plan. Partners with internal work teams, often leading such project teams, to complete organizational priorities. Ensures that engagement with contracted providers is consistent and in line with contract obligations.


ESSENTIAL JOB FUNCTIONS:

Network Development

  • Serve as the network development project lead for assigned network development projects
  • Facilitate cross-departmental workgroups to support the successful implementation of network development projects
  • Assist in the development of contractual scopes of work for new network development projects
  • Review and present network development budgets for approval within the Vaya service budget
  • Liaison with NC DHHS and other state officials on project development and funding allocations
  • Complete assigned elements of the Network Access Plan, ensuring completion of assigned elements by date identified and present information to internal and external stakeholders as assigned
  • Complete assigned elements of the network development plan ensuring completion of assigned elements by date identified and present information to internal and external stakeholders as assigned
  • Lead and support the submission of grants to meet identified network needs
  • Assist with the recruitment of new network providers into the network including formal Requests for Proposal (RFP), as necessary
  • Manage provider requests to enter the closed network (nomination forms) and make recommendations to Vaya identified committee’s regarding entrance into the network based upon guidelines in the selection and retention policies
  • Maintain projects plan/and or checklists for development of all assigned network development projects
  • Review and resolve internal requests for population specific service needs (provider network service gap referral forms) against the annual network development plan and Network Access Plan and make recommendations to identified Vaya committee’s regarding need for requests for proposals
  • Review and resolve internal requests for member specific service needs (provider network service gap referral forms) against the available resources in the network and funding streams available to the member and coordinate requests for services as deemed appropriate
  • Assist with development of network training initiatives and manage coordination with external education vendors
  • Review provider requests for letters of support required by state licensure rules against identified network needs and provide letter of support or denial of request within 14 calendar days


Network Management

  • Conduct and review analysis of the provider network and determine areas of gaps and needs
  • Monitor IDD service utilization data to ensure timely access to care
  • Assist in the development and ongoing updating of the Network Access Plan
  • Coordinate with network providers and community stakeholders to optimize services to effectively work for members and obtain targeted quality driven outcomes that meet all required network adequacy standards
  • Produce reports for internal and external partners demonstrating network adequacy standards and service availability
  • Conduct and disseminate surveys from internal and external stakeholders to determine gaps in services
  • Participate in community health assessments to support the development of needed services within local communities
  • As assigned, liaison with disability specific Provider Advisory Council subcommittees on gaps analysis/network development plan and establish due dates for information sharing
  • Attend internal critical case staffing conference calls as requested or directed to provide education regarding service resources in the network
  • Manage out of network agreement (OON) requests, evaluate against established criteria, and identified gaps, and provide recommendation to approve, add or deny requested agreement per established policies
  • Complete assigned elements of provider cultural competency plan ensuring completion by date identified each calendar year and present information to internal and external stakeholders as assigned
  • Provide expertise for stakeholder’s groups mandated by contract and as assigned


QUALIFICATIONS & CREDENTIALING REQUIREMENTS:

Bachelor's degree is required with:

  • 2-5 years relevant network development experience required.
  • 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

Master's degree is preferred.


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.


KNOWLEDGE OF JOB:

  • Knowledge of the Innovatiosn Waiver and approved services and supports
  • Expert level of knowledge of Center for Medicare and Medicaid Services (CMS) 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


LOCATION REQUIREMENT:

In accordance with the BH and I/DD Tailored Plan requirements mandated by the NC Department of Health and Human Services, certain Vaya Health positions are required to be filled by individuals who reside in North Carolina, meaning someone who establishes a legal domicile in North Carolina and pays income tax in North Carolina, or resides within 40 miles of the North Carolina border. New hires from outside of North Carolina will have 60 days from the date of hire to meet this requirement, if applicable to the position.

This position is required to reside in North Carolina or within 40 miles of the North Carolina Boarder.


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 http://www.vayahealth.com/careers-overview/ Ind.001.


Vaya Health is an equal opportunity employer.

Vaya Health

Address

Asheville, NC
28806 USA

Industry

Technology

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