Provider Network Development Specialist I at Alliance Health in Morrisville, North Carolina

Job Description:

The Provider Network Development Specialist I supports the development and management of the Provider Network, including assisting with the development of a comprehensive array of services and recruiting new providers to fulfill network needs and address gaps in service.

Responsibilities and Duties

Develop the Provider Network

• Assist with the creation of Requests for Proposals to facilitate development of a comprehensive array of services for members


• Assist with the creation of contracts and scopes of work for identified programs and agencies


• Develop Scopes of Work for programs and initiatives (non-UCR and Medicaid) for assigned agencies; lead the process from creation to finalization and approval of the scope, negotiate functional terms of the scope in conjunction with the provider and internal departments, oversee outcome/performance measures, and ensure program is implemented.


• Be knowledgeable of assigned provider contracts with agencies and organizations in conjunction with Alliance’s Finance and Contract departments. Ensure assigned providers contracts are completed with applicable scopes of work each contract year.   Provide input into the development/termination of contracts; ensure reporting requirements are completed as required


• Analyze, review, and approve invoices in conjunction with contractual terms, discuss rate changes, funding and other changes that impact provider contracts, with Provider Network Development Supervisor and /or the Provider Network Operations Manager


• Provide onsite assessment/evaluation of scope of work to determine if provider is maintaining fidelity and meeting outcomes as identified on contracted scope, and provide technical assistance as needed.


• Assist in recruiting and securing, and retaining, qualified and capable providers to provide evidence-based and best practice services


• Participate and make recommendations in the process of identifying new services and supports necessary to address gaps in the service array

Work collaboratively with the providers to develop best practices and provide guidance and training

• Work with Providers to evaluate Evidence Based and Best Practice services for members are available; maintain awareness of fidelity elements and adherence to those standards


• Encourage providers to incorporate member and family involvement


• Support the development of Best Practices and addresses the necessity of the need for a comprehensive and integrated system of care that involves behavioral and physical social determinants of health.


• Based on needs of provider community, arrange and coordinate trainings, in collaboration with Alliance’s Organization Development & Learning department; 


• Provide guidance and technical assistance for new and existing providers, for the use of local and state funds, and around service delivery and adherence to best practice standards and contractual requirements

Evaluate Out of Network requests

• Evaluate Out of Network requests (OON), reviews and approves or denies requests. Evaluate merit based on network capacity. 


• Negotiate single case agreements as needed within established time lines to support access to services

Collaborate with internal and external stakeholders

• Serve as liaison between providers and Alliances’ functional areas, and as a primary point of contact for assigned providers;


• Establish and maintain relationships and collaborations with relevant public, private, and provider agencies, in order to assure open communications, avoid misunderstanding and support solution focused atmosphere within the community;


• Facilitate or co-facilitate local and regional collaborative teams/efforts and steering committees


• Participate in organized community events

Maintain knowledge of area of focus to provide assistance and guidance to providers

• Acquire and maintain knowledge of the current services and supports available within the Catchment area and available to consumers within North Carolina


• Acquire and maintain knowledge of best practices in area of responsibility, use knowledge to assist, guide and support providers in the development and maintenance of comprehensive, outcome focused consumer services

Ensure compliance with Federal, State, and local regulations and accreditation standards

• Help to ensure all applicable NCQA standards relating to Provider Network development functions/responsibilities are followed as required.


• Review State Plan documents, Alliance Business Plan, and Best Practice Protocols to ensure local services/system development are in compliance; provide assistance and consultation to assure that written policies and procedures are kept current with the aforementioned

Minimum Requirements

Bachelor’s degree in a Human Services field from an accredited college or university and five (5) years progressive post-degree experience in the behavioral health (mental health/substance use) field;

Or

Master’s degree in Human Services from an accredited college or university with three (3) years post graduate experience in the behavioral health (mental health/substance use) field; Experience and knowledge in Behavioral Health (mental health/substance use)

Special Requirement-Valid NC Driver's license required.

Knowledge, Skill, and Abilities

• Knowledge of the principles, concepts, and Best Practices used in the treatment, habilitation and support of individuals 


• exceptional interpersonal skills


• highly effective communication skills


• Problem solving and conflict resolution skills


• Proficient with Microsoft Office suite of programs


• Proficient with database management


• Strong Multitasking skills


• Time management skills


• Mediation skills


• Ability to navigate health and hospital systems


• Ability to determine the appropriate course of action in an emergency or stressful situation


• High level of diplomacy and discretion


• Ability to negotiate and resolve issues independently


• Ability to communicate and facilitate work across multiple departments within Alliance and with external stakeholders


• Ability to make prompt independent decisions based upon relevant facts


• Ability to review and analyze data in an effort to evaluate program effectiveness, progress, problems, and system performance


• Ability to identify and analyze administrative problems pertinent to the contract, and make logical conclusions, recommendations and decisions

Salary Range

$22.15 - $38.14/Hourly

Skills

Required

• Relationship Building


• Critical Thinking


• Collaboration

Behaviors

Required

• Innovative: Consistently introduces new ideas and demonstrates original thinking


• Enthusiastic: Shows intense and eager enjoyment and interest


• Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well


• Dedicated: Devoted to a task or purpose with loyalty or integrity


• Team Player: Works well as a member of a group

Motivations

Required

• Ability to Make an Impact: Inspired to perform well by the ability to contribute to the success of a project or the organization


• Self-Starter: Inspired to perform without outside help


• Flexibility: Inspired to perform well when granted the ability to set your own schedule and goals

See job description

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