Provider Network Service Development Specialist (Full-time Remote, North Carolina Based) (Finance)
The Provider Network Service Development Specialist supports the development and management of the Provider Network, including assisting with the expansion of current services, development of new services, and recruiting providers to fulfill network needs. This position will assist with Alliance's networks gaps and needs analysis to help ensure Alliance Health has an adequate provider network. This position will also assist in the coordination of cross-departmental initiatives, identified internally or by the State of NC and assist in the oversight of Provider Network activities related to special initiatives, with a focus on network adequacy, current services expansion and new service implementation.
This position is full-time remote. The selected candidate must reside in North Carolina. Some travel for onsite meetings at the home office maybe required.
Responsibilities & Duties
Expand Current Services Network
- Assess current network adequacy and recommend expansion of current services to address gaps in the service array
- Research current services that need expansion
- Assist in recruiting and retaining qualified and capable providers to assist in the expansion of current services
- Analyze funding incentives and disincentives for best practices
Identify New Services
- Identify and recommend new services and supports to address gaps in the service array
- Research new services identified
- Assist in recruiting and retaining qualified and capable providers to provide new services
- Analyze funding incentives and disincentives for best practices
Oversee Activities Related To New Service Implementation And Current Services Expansion
- Review and approve the addition of new services to existing providers
- Develop Scopes of Work (SOW) and lead the process to finalize the SOW and gain approval
- Ensure all programs, services, and systems are developed in accordance with Local, State and Federal Performance Standards, and congruent with Alliance organizational and procedure manuals
- Assist in the identification and coordination of internal and external training needs as it relates to new service development and or current service expansion
- Develop and lead new Provider Collaboratives related to new service, current service expansion or pilot project implementation
Provide Technical Assistance And Customer Service To Network Providers
- Ensure that Evidence Based and Best Practice services for consumers are in place as identified and are available for consumers
- Assist, guide and support providers in the development and maintenance of comprehensive, outcome focused consumer services
- Be knowledgeable of assigned provider contracts with agencies and organizations in conjunction with Alliance's Finance and Contract departments
- Provide technical assistance and feedback for the use of local and state funds, new service delivery and adherence to best practice standards and contractual requirements
Internal and External Collaboration
- Collaborate directly with Alliance Health Provider Network Leadership to review network adequacy data to help identify and expand current services
- Arrange and facilitate interdepartmental, provider and State personnel workgroups
- Represent Alliance on State Committees, as applicable
- Assist in the coordination of cross-departmental Initiatives as identified
- 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
- Participate in the creation of and attend and or lead newly created Provider Learning Collaboratives
Out Of Network (OON) Review
- Evaluate Out of Network requests based on Network capacity and approve or deny requests
Collaborate with Internal Departments To Develop Solutions To Identified Needs
- Partner with Health Care Project Management Team, Claims, Business Operations, Medical Management, and other areas to address ongoing needs and develop solutions
Minimum Requirements
Education & Experience
Bachelor's degree in a Human Services field from an accredited college or university and five (5) 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 three (3) years post graduate experience in the field of Mental Health, Substance Use, Intellectual/Developmental Disabilities or Physical Health.
Preferred:
Previous Provider Network experience
Previous Project Management experience
Previous Network Adequacy analysis experience and development of new services and programs
Licensure and/or certification in area served is preferred
Knowledge, Skills, & Abilities
- 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 build relationships
- Ability to make prompt 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
Salary Range
$32.80 - $41.82/Hourly
Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity.
An excellent fringe benefit package accompanies the salary, which includes:
- Medical, Dental, Vision, Life, Long Term Disability
- Generous retirement savings plan
- Flexible work schedules including hybrid/remote options
- Paid time off including vacation, sick leave, holiday, management leave
- Dress flexibility
Education
Required- Bachelors or better in Human Services
- Masters or better in Human Services
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
