Provider Network Operations Specialist

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Assist in the development and management of the Provider Network.

• Oversee and ensure the accuracy of Provider Scopes of Work (SOW).

• Perform clinical and financial SOW assessments in accordance with established guidelines.

• Conduct biannual meetings with providers to discuss SOWs and additional meetings as necessary.

• Organize and facilitate interdepartmental meetings for SOW reviews.

• Submit SOWs for contract routing for the upcoming fiscal year.

• Confirm that assigned provider contracts incorporate relevant SOWs each contract year.

• Offer technical support, education, and customer service to network providers.

• Supervise the Provider Hub and disseminate relevant information.

• Investigate and resolve provider-related issues.

• Deliver targeted communications to providers as required.

• Complete necessary reporting tasks.

• Analyze funding and financial data to suggest future funding opportunities.

• Address funding issues and ensure compliance with best practices among providers.

• Guarantee that evidence-based and best-practice services are accessible to members.

• Stay informed about fidelity elements and compliance with standards.

• Assist providers in developing and sustaining comprehensive, outcome-driven member services.

• Adhere to relevant NCQA standards for Provider Network Development functions.

• Collaborate with various departments and external stakeholders.

• Represent Alliance in state calls, provider collaboratives, Provider Advisory Council meetings, and community crisis collaboratives.

• Aid in crafting agendas and present at All Provider Meetings and Alliance Provider Advisory Council meetings.

• Facilitate designated provider collaboratives.

• Cultivate and maintain partnerships with public, private, and provider agencies.

• Monitor provider contracts and recommend development or termination of contracts.

• Review and authorize invoices in line with contractual agreements.

• Discuss modifications to rates, funding, and other contract-related changes with management.

• Support special initiatives, including Letters of Support, HCBS, Waiver Requests, and Transition to Community Living.

• Monitor expenditures and adjust funding caps across departments.

• Update and maintain Scopes of Work.

⛳️ Requirements

• A Bachelor’s degree in a Human Services field from an accredited institution and three (3) years of progressive post-degree experience in Mental Health, Substance Use, Intellectual/Developmental Disabilities, or Physical Health; OR a Master’s degree in Human Services from an accredited institution with one (1) year of post-graduate experience in those areas.

• Experience in Provider Networks is preferred.

• Knowledge of disability sectors, including Mental Health, Substance Use, and Developmental/Intellectual Disabilities.

• Familiarity with treatment, habilitation, support principles, concepts, and Best Practices.

• Understanding of systems affecting Providers.

• Proficiency in Microsoft Office suite, particularly Excel.

• Skills in database maintenance.

• Excellent interpersonal abilities.

• Highly effective verbal and written communication skills.

• Strong problem-solving, organizational, and conflict resolution abilities.

• Public speaking and training expertise.

• Mediation proficiency.

• Ability to negotiate and resolve issues with diplomacy and discretion.

• Capacity to make swift independent decisions based on pertinent facts.

• Competence in reviewing and analyzing data to assess program effectiveness, progress, issues, and system performance.

• Capability to collaborate effectively with both internal and external stakeholders.

• Ability to identify problems and initiate solutions proactively.

• Must demonstrate initiative and employ critical thinking skills.

• Residency in North Carolina is required.

• Willingness to travel to an office for business or onsite team meetings as necessary.

• Occasional local site visits to providers may be required.

🏝️ Benefits

• Full-time remote work opportunity.

• Occasional travel to offices for business or onsite team meetings as necessary.

• Equal Opportunity Employer.