Provider Quality Assurance Manager

LOCATION : Remote - must live in / near any of Vaya's catchment areas in North Carolina. Preference given to qualified candidates in / near Burlington, North Carolina.

Must be willing to travel as needed.

GENERAL STATEMENT OF JOB

The Provider Quality Assurance Manager is responsible for providing leadership and oversight of provider monitoring functions, as well as the day-to-day coaching / guiding of the Network Quality and Performance Team (NQPT) members - in conjunction with and under the supervision of the Provider Quality Operations Director - to ensure that all monitoring activities are being carried out in a competent, thorough, and consistent manner in compliance with Federal and State regulations and Vaya Health policy.

This position is also responsible for oversight of the assessment of services delivered to Members to ensure that services delivered are consistent with funding requirements, best practices, provider's contracts and federal / state rules and regulations.

As needed, the Provider Quality Assurance Manager will work with a team of reviewers to identify instances of non-compliance that impact service / system quality.

In addition, and as needed, the Provider Quality Assurance Manager will monitor the implementation of interventions aimed at addressing areas of non-compliance, to ensure services are being delivered to members according to all applicable rules, regulations, and best practice models and to ensure the health and safety of members.

ESSENTIAL JOB FUNCTIONS

Provider Quality Assurance Oversight and Supervisory Responsibilities :

• Direct oversight of regulatory and contractual provider monitoring activities that include (but are not limited to) Post-Payment Reviews, block grant reviews, investigations, health and safety reviews, and C Waiver monitoring.
• Collaboration in the development, review, and revision of internal processes / protocols related to Provider Quality Management Operations.
• Develop process flows and job aides for training and execution to effectively manage and develop the NQPTT.
• Provide day to day support of NPU team members / activities, which includes the hiring, training, and ongoing supervision of staff.
• Provide ongoing staff development and support in the accomplishment of department responsibilities and performance goals, as well as conduct performance evaluations.
• Development / maintenance of tracking and monitoring systems for quality assurance activities according to regulatory requirements, accreditation standards, policies and procedures, and contractual requirements.
• Review of reports and data to identify trends / patterns that impact service quality / delivery and develop solutions to address non-compliances.
• Collaborate with internal teams and external stakeholders to develop quality solutions when opportunities for improvement are identified.

Special Projects and Committee Involvement :

• Assist the Provider Quality Operations Director and Vice President with special projects and assignments directly related to quality assurance and provider monitoring and lead such projects as assigned.
• Work in collaboration with the Quality Management leadership team on departmental projects.
• Provide representation on Vaya Health committees as assigned and serve as proxy for the Provider Quality Operations Director.
• Participate in any external committees / workgroups as assigned by the Provider Quality Operations Director.
• Attend state meetings as needed / assigned to stay informed and maintain a current knowledge base of performance metrics and local, state, and federal requirements.

KNOWLEDGE, SKILL & ABILITIES :

• A strong knowledge of state and federal rules, requirements, regulations, and practices related to the service continuum in North Carolina is imperative.
• Must possess strong leadership skills and the ability to be effective in getting tasks done while working through other people.
• Requires exceptional interpersonal skills and the ability to work respectfully with a wide variety of individuals with diverse ethnicities, cultures, and abilities, and possess the ability to negotiate effectively in working with teams, providers and other departments to address issues of concern.
• A high level of diplomacy and discretion is required to effectively negotiate and resolve issues, and problem-solving and conflict resolution skills are essential.
• Must be self-motivated and able to work with a wide variety of individuals and possess the ability to negotiate effectively in working with teams, providers and other departments to address issues of concern.
• Must possess highly effective communication skills and the ability to present information effectively across a variety of audiences, and to respond to questions from internal and external stakeholders.
• Must be detail oriented with strong organizational skills to independently manage multiple tasks in a time effective manner.
• Proficiency in Microsoft Office products (such as Word, Excel, Outlook, Teams, etc.) is necessary, with the capacity to quickly learn new software tools.

QUALIFICATIONS & EDUCATION REQUIREMENTS

Bachelor's degree in Human Services (Psychology, Social Work, etc.) required. Master's degree preferred. Must have :

• At least three years of experience in the field of mental health, intellectual / developmental disabilities, or substance use disorders is required.
• At least two years of experience in quality management / improvement / assurance
• At least two years of experience in management / supervision

Required Licensure / Certification :

• CLEAR / NCIT - Basic Certified Investigator (should be obtained within the first 9 months of employment)
• CLEAR / NCIT - Specialized Program Certification (should be obtained within the first 18 months of employment)

Preferred Work Experience :

• At least four years of progressive experience in the field of mental health, intellectual / developmental disabilities, or substance use disorders is preferred.
• Experience in quality improvement and management / supervision is also preferred.

Preferred Licensure / Certification :

Clinical License (including but not limited to : RN, LPC, LCSW, LCAS)

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 person in this position must reside in North Carolina or within 40 miles of the NC border. Preference given to qualified candidates in the Burlington, NC area .

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 https : / / www.vayahealth.com / about / careers / .

Vaya Health is an equal opportunity employer.