Provider Network Operations Specialist (Full-time Remote, North Carolina Based)

The Network Operations Specialist supports the development and management of the Provider Network by managing scopes of work, providing technical assistance, and monitoring provider contracts.  Incumbents also support operational activities related to special initiatives.

Manage Provider Scopes of Work (SOW)

• →Ensure information in the Scopes of Work is up-to-date and accurate
• →Conduct Scope of Work reviews, both clinical and financial, in accordance with established procedures to ensure provider is meeting requirements and producing expected outcomes
• →Meet with Providers to review Scope of Work twice per year and ongoing if needed
• →Organize and lead interdepartmental meetings to ensure Scopes of Work are reviewed as needed
• →Ensure Scopes of Work get routed into contracts for the following fiscal year
• →Ensure assigned providers’ contracts are completed with applicable scopes of work each contract year

Provide technical assistance and customer service to network providers 

• →Oversee the Provider Hub, including monitoring and sharing information
• →Provide education and technical assistance to Providers
• →Research and Troubleshoot Provider Issues
• →Provide more targeted communication with providers as directed and assigned
• →Ensure reporting requirements are completed as required
• →Review ongoing funding and financial information to make recommendations for future funding 
• →Troubleshoot with provider on any funding issues and/or adherence to best practices
• →Ensure that Evidence Based and Best Practice services for members are in place as identified and are available for members. Maintain awareness of fidelity elements and adherence to those standards
• →Assist, guide and support providers in the development and maintenance of comprehensive, outcome focused services for members.
• →Ensure all applicable NCQA standards relating to Provider Network Development functions/responsibilities are followed as required

Collaborate with other departments, and external stakeholders

• →Collaborate with other departments and external Stakeholders
• →Provide support related to the Provider Network to other departments such as Care Management, Finance, Provider Network Evaluation
• →Represent Alliance, as directed and assigned, in Point of Contact calls with the State, longstanding provider collaboratives, local Provider Advisory Council (PAC) meetings, community crisis collaboratives, etc.  
• →Assist in the development of the agenda and presenting as needed at the All Provider Meetings and Alliance Provider Advisory Council
• →Facilitate established provider collaboratives as assigned
• →Establish and maintain relationships and collaborations with relevant public, private, and provider agencies, in order to assure open communication, avoid misunderstanding and support solution focused atmosphere within the community

Monitor Provider Contracts

• →Make recommendations on the development and termination of provider contracts
• →Be knowledgeable of assigned provider contracts with agencies and organizations in conjunction with Alliance’s Finance and Contract departments
• →Analyze, review, and approve invoices in conjunction with contractual terms
• →Discuss rate changes, funding, and other changes that impact provider contracts with department management

Support operational activities related to special initiatives

• →Oversee Letters of Support, Home and Community Based Services (HCBS), Waiver Requests, and/or Transition to Community Living initiatives
• →Monitor spending and work across departments to revise funding caps
• →Revise and Maintain Scopes of Work

Required:

Bachelor’s degree in a Human Services field from an accredited college or university and three (3) years progressive post-degree experience in the field of Mental Health, Substance Use, Intellectual/Developmental Disabilities or Physical Health. 

OR 

Master’s degree in Human Services from an accredited college or university with one (1) years post graduate experience in the field of Mental Health, Substance Use, Intellectual/Developmental Disabilities or Physical Health. 

Preferred:

Provider Networks experience preferred.

• Knowledge of Alliance’s goals, targets, and outcomes in relation to the responsibilities of the Provider Network Operations department. 
• Knowledge of all disability areas including Mental Health, Substance Use and Developmental/Intellectual Disabilities
• Knowledge and understanding of principles, concepts, and Best Practices used in the treatment, habilitation and support of individuals with needs in any of the disability areas
• Knowledge and understanding of the different systems that impact Providers
• Microsoft Office suite, including Excel
• Proficient with database maintenance
• Exceptional interpersonal skills
• Highly effective Communication skills
• Problem solving skills 
• Organizing skill
• Conflict resolution skills
• Effective public speaking and training skills
• Strong mediation skills in order to facilitate collaboration and positive relationships
• High Level of diplomacy and discretion to effectively negotiate and resolve issues independently
• 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 work effectively with others internally and externally
• Ability to effectively identify problems, and initiate solutions
• Ability to take initiative and utilize critical thinking