About Vaya Health
Vaya Health is a leader in the healthcare industry, dedicated to providing innovative solutions for individuals with mental health, developmental disabilities, and substance use disorders. Our mission is to empower individuals to live fulfilling lives, and we're committed to delivering exceptional care and support. As a remote BH & IDD PN Contract Manager, you'll play a vital role in driving our success and making a meaningful impact in the lives of our members.
Job Summary
We're seeking an experienced BH & IDD PN Contract Manager to join our team in a remote capacity. As a key member of our provider network development and management team, you'll be responsible for maintaining ongoing relationships with community stakeholders and leaders, driving the improvement of provider performance, and ensuring the highest level of customer service. If you're a motivated, team player with a passion for healthcare and a strong background in provider relations, we encourage you to apply.
Key Responsibilities
- Facilitate provider education and training to increase provider familiarity, alignment, and satisfaction with Vaya Health's systems, expectations, and strategies.
- Study and design innovative 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 workflows 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 the 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 the 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.
Essential Qualifications
We're looking for a highly motivated and experienced professional with a strong background in provider relations and a passion for healthcare. The ideal candidate will possess:
- Expert-level 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 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
We're seeking a candidate with a Bachelor's degree required and a Master's degree preferred. The ideal candidate will have 2-5 years of experience in a provider relations-related role handling complex network providers in the healthcare industry with accountability for business results preferred.
Preferred Experience
- Experience developing and writing contracts and utilizing financial modeling in making rate decisions preferred.
Preferred Licensure/Certification
- License or license eligible in NC preferred but not required – Preferences are LCSW, LCAS, and/or LMHC.
- Certifications in use of project management methodologies preferred.
Physical Requirements
The ideal candidate will be able to perform the following 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 ideal candidate must reside in North Carolina or within 40 miles of the NC border.
Salary
The salary for this position will be competitive and based on the candidate's qualifications and experience.
Benefits
Vaya Health offers a comprehensive benefits package, including:
- Competitive salary.
- Health, dental, and vision insurance.
- Retirement plan with employer match.
- Flexible work arrangements, including remote work options.
- Professional development opportunities.
- Recognition and rewards for outstanding performance.
How to Apply
If you're a motivated and experienced professional with a passion for healthcare, we encourage you to apply for this exciting opportunity. Please submit your application through our Career Center at https://www.vayahealth.com/about/careers/. We look forward to hearing from you!
About Vaya Health
Vaya Health is an equal opportunity employer and welcomes applications from diverse candidates. We're committed to creating an inclusive and supportive work environment that values diversity, equity, and inclusion. If you're passionate about making a difference in the lives of others, we encourage you to join our team!
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