Vaya Health

Provide reporting and data support for program performance, monitor measures, and present findings to stakeholders. | Bachelor's degree and 2+ years managing data in large databases, preferably in health sectors. | LOCATION: Remote – this is a home-based, virtual position that operates Monday – Friday from 8:30am-5:00pm EST. This person must live in North Carolina or within 40 miles of the NC border.   GENERAL STATEMENT OF JOB The ROOTS Hub Performance Reporting Analyst reports to the ROOTS Hub Director and provides reporting and data support for NC DHHS’ define region 3 comprised of Alexander, Anson, Cabarrus, Catawba, Cleveland, Gaston, Iredell, Lincoln, Mecklenburg, Rowan, Stanley and Union counties. The position will support ROOTS Hub Lead operations with the production of all required reports and the analysis, tracking and trending of program-related data. ESSENTIAL JOB FUNCTIONS * Compile, submit, and aggregate program-related reports to the Department by required deadlines * Support the Hub Director in ensuring subrecipients, implementation partners, and community-based organizations meet reporting expectations * Gather, develop, review, analyze and monitor performance measures and results required by NC DHHS to ensure compliance and comprehension and to identify potential improvement opportunities. * Present results, findings, interpretations, and recommendations regarding performance measures to both internal and external stakeholders  Other duties as assigned. KNOWLEDGE, SKILLS, & ABILITIES * Strong project management and administration background with the ability to work with organization leadership and stakeholders to present data and results * Ability to develop organizational performance reports according to standard templates * Ability to analyze data to identify root causes and develop an approach for responding * Ability to complete tasks in a timely and accurate manner * Excellent time management skills and the ability to manage competing priorities and projects * Strong organizational skills with attention to detail and the ability to multi-task * Ability to work independently with little or no direction, demonstrate initiative, be goal-oriented, and function as a self-starter * Ability to solve problems and provide practical, thorough and creative solutions to work tasks EDUCATION & EXPERIENCE REQUIREMENTS Bachelor’s degree in Human services, finance, business administration, computer science or related fields is required.  * Minimum of two (2) years of experience managing the input and output of data in large databases for enterprise-level organizations, preferably organizations connected to behavioral or physical health. Preferred work experience: * Minimum of two (2) years’ experience working with Medicaid/Medicare, population health, behavioral health, I/DD and/or TBI data preferred 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 REQUIREMENTS: The person in this position is required to reside in North Carolina or within 40 miles of the NC border.   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/ [https://www.vayahealth.com/about/careers/]. Vaya Health is an equal opportunity employer.

Provide administrative and program support for Utilization Management including managing communications, coordinating peer reviews, supporting transition of care processes, and preparing documentation for audits. | High school diploma or equivalent with 4-5 years of administrative experience or related education and experience, strong verbal and written communication skills, intermediate Microsoft Office skills, and residency within 40 miles of North Carolina border. | LOCATION: Remote – must live in/near Vaya’s catchment area in North Carolina or within 40 miles of the NC border. Must have the ability to come into Vaya's Asheville NC offfice as needed. GENERAL STATEMENT OF JOB This position provides program assistance and administrative support for the Utilization Management team. This position involves extensive work using the Administrative Health Record system(s) to coordinate care for members, beneficiaries and recipients transitioning to and from Vaya’s Health Plans and managing referrals to delegated UM vendors. In addition, the employee participates in collecting and monitoring various forms of data. The employee also interacts with members, recipients, beneficiaries, providers, stakeholders, vendors, NC Department of Health & Human Services, and the public by providing information and other forms of assistance. The employee provides an array of administrative support services to teams within Utilization Management including meeting scheduling, recording notes and minutes, and organizing document storage. This position may also provide assistance as necessary with the Transition of Care process. The incumbent must be located within a reasonable commuting distance from Vaya’s home office. Position is eligible for primarily remote work; however, incumbent must be able to work from Vaya’s office when needed as directed by supervisor and Utilization Management leadership. ESSENTIAL JOB FUNCTIONS Administrative Assistant for Utilization Management/Appeals: The position provides administrative coordination and support to help maintain, evaluates, and improves Utilization Management functions, including the management of departmental communications (e.g., email inbox, fax, and phone line/voicemail, etc.), the coordination of departmental business process, including annual internal reviews, participation in Utilization Management meetings, and development and distribution of minutes and training materials as needed. This position shares responsibility for managing the Peer Review Desk as part of the clinical peer reviews conducted during the Utilization Management review process for service authorization requests. • Gathers information for referral to peer reviewer • Organizes, sends, and tracks all assigned peer reviews to ensure timeliness of completion • Gathers completed reviews from delegated vendors and formats decisions for members’ administrative health records • Communicates with the Member Appeals Team regarding Peer Review Desk functions This position provides support for transition of care for Vaya’s members and beneficiaries by ensuring that people transitioning to and from Vaya’s Health Plan experience seamless transitions of care. Primary duties are as follows: • Liaise with Standard Plan (SP) Prepaid Health Plans (PHPs), other Tailored Plans (TPs), and Tribal Option Plan • Review prior authorizations from former insurers and ensure that UM enters authorizations to honor these • Ensure that Out of Network Agreements are executed timely to ensure continuity of care • Obtain appropriate releases of information to support continuity of care when members transfer to and from • Vaya’s plan • Outreach new members transitioning from another PHP, TP, or Tribal Option Plan • Respond timely to requests for information from other insurers or vendors • Ensure that Vaya sends appropriate documentation for high acuity members transitioning to another plan to the receiving plan Administrative Support for Utilization Management: This position supports the RN UM Clinician Supervisor and other UM leadership and staff by providing administrative and clerical functions, including support for administering Value Added Services. The employee maintains files and provides support for projects as needed. This position collects data as requested to help maintain, coordinate, and evaluate Utilization Management functions. The employee schedules, hosts, and participates in Utilization Management meetings, and develops and distributes information/minutes as needed. The employee interacts with members, beneficiaries, recipients, stakeholders, providers, vendors, and the public in providing information and addressing their questions and concerns. The employee distributes mail, monitors fax accounts, and provides coverage for staff as requested. Documentation & Audit Preparations: This position prepares documentation for reviews and audits as needed, compiling, and uploading data as specific reviews dictate. Other Duties: Other Duties as assigned. KNOWLEDGE, SKILLS, & ABILITIES This position requires excellent verbal and written skills. Additionally, it requires familiarity with a wide variety of software packages and the Administrative Health Record(s). Strong people skills are required to promote excellent communication with staff at all levels, members, and the general population. This position requires skill in organizing workflow. Ability to analyze and interpret policy and procedural guidelines is necessary. Intermediate level Microsoft Office software proficiency is required. EDUCATION & EXPERIENCE REQUIREMENTS High school diploma or equivalent and 4-5 years of progressively responsible secretarial or clerical/administrative/office management experience OR Two-year secretarial science or business administration program and 2 years of progressively responsible secretarial or clerical/administrative, office management experience OR Four-year program in a college or university preferably with major emphasis on coursework in business administration, public administration, or other related field; 1 year of experience. Preferred work experience: • Experience and/or education in the healthcare field is a plus, but not required. MENTAL/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 is required to reside in North Carolina or within 40 miles of the North Carolina border. SALARY: Depending on qualifications & experience of candidate. This position is non-exempt and is 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.

Monitor and triage quality of care concerns, conduct health and safety checks, collaborate with stakeholders, and ensure compliance with provider contracts and regulations. | Bachelor’s degree in Human Services or related field with 2+ years experience in mental health or related fields, NC Qualified Professional preferred, and CLEAR/NCIT Basic Certified Investigator certification within 9 months. | LOCATION: Remote – may live anywhere in Vaya’s catchment area in North Carolina; however, there is a preference for the Charlotte NC area. This position requires travel as needed. GENERAL STATEMENT OF JOB The Provider Quality of Care Specialist serves as a vital member of the Quality Management Department and reports directly to the Provider Quality Assurance Manager. This position plays a critical role in ensuring the delivery of safe, high-quality and compliant services across Vaya’s provider network. Key responsibilities include assessing and responding to quality-of-care concerns and completing health and safety screenings. The person in this position triages quality of care concerns entered in Vaya’s EthicsPoint database and collaborates with internal and external stakeholders to address concerns and ensure timely follow-up. This role is also responsible for appropriately escalating urgent member concerns to department leadership and contributing to the development of solutions that support member safety. This position ensures that provider services delivered are consistent with funding requirements, best practices, provider's contracts, and federal/state rules and regulations. Research, reporting, and providing technical assistance are key functions of this role to support continuous quality improvement. Additionally, this role involves coordinating and performing - in-person screenings at home and community-based settings to ensure member health and safety. ESSENTIAL JOB FUNCTIONS The incumbent in this position serves as part of a monitoring team and will work as a part of that team to complete monitoring of network providers. Responsibilities include: Triage Quality of Care Concerns and complete required follow up review activities: • Monitor and triage quality of care concerns received in Vaya’s EthicsPoint database. Review new quality of care concerns and determine appropriate follow-up action needed to address any identified issues. Follow-up actions may include, but are not limited to: • Researching provider contract requirements, State and Federal regulations, member service history, and incident report information. • Conducting outreach to request pertinent case information from providers, Vaya staff, and external stakeholders. • Staffing urgent quality of care and health and safety concerns with the Provider Quality Assurance Manager. • Escalate concerns to Quality Management leadership as appropriate. • Support work-flow management by partnering closely with the Provider Quality Assurance Manager to ensure tasks assigned to the team are complete and meet set timelines. • Report concerns to external regulatory agencies as needed. • Provide technical assistance to educate providers on contractual requirements. • Complete case notes and update all required case fields in EthicsPoint to document activities within required timelines. • Participate in multidisciplinary meetings and contribute to quality improvement initiatives as assigned. Health/Safety Checks: • Collaborate with the Provider Quality Assurance Manager to coordinate announced or unannounced Health and Safety Checks. • Conduct announced or unannounced Health and Safety checks as needed and/or assigned to assess quality of care and ensure member Health and Safety. • Complete documentation from reviews as requested • Complete announced unlicensed alternative family living (UAFLs) reviews to assess compliance with health and safety requirements for urgent and expedited placements. Serve as back up for UAFL reviews. • Review HCBS assessments for any urgent and expedited placements as assigned. Other duties as assigned: • Serve as an additional reviewer for focused reviews and investigations. • Review provider Plans of Correction as assigned. • Assist in developing dashboards and presentations for internal and external stakeholders. • Review and process Relative as Direct Support Employee (RADSE) requests as assigned. KNOWLEDGE, SKILLS, & ABILITIES Success in this position requires exceptional interpersonal skills, and highly effective communication ability. A high level of diplomacy and discretion is required to effectively negotiate and resolve issues. In addition, the person in this position must have: • Knowledge of state and federal rules, requirements and practices related to the service continuum in North Carolina. • Knowledge of policy and procedure is essential related to monitoring plans of correction and resolution. • Ability to analyze and interpret policy and procedural guidelines. • Ability to problem solve, critically think, analyze, interpret and apply data obtained and make recommendations to support member safety and business needs. • Ability to work independently with little or no direction, demonstrate initiative, and function as a self-starter. • Excellent time management skills and the ability to reprioritize in a fast-paced environment and keep up with multiple, possibly competing, priorities. • Effectively work in a complex healthcare environment in a highly collaborative manner keeping all stakeholders informed as appropriate. • A high level of diplomacy and discretion is required to effectively negotiate and resolve issues. • Strong negotiation and conflict resolution skills to manage sensitive issues and drive consensus. • Ability to establish and maintain positive and effective working relationships with others. • Experience in assigning tasks, managing workloads, and monitoring team performance to ensure quality and timeliness. • Ability to anticipate challenges, assess risks, and make informed decisions that support members’ safety and service quality. • Ability to effectively present information and respond to questions from internal and external stakeholders in a professional and concise manner. • Excellent computer skills; proficiency in Microsoft Office Suite; and experience creating documents, forms, and graphs. • Skilled in organizing workflow and strong detail orientation. • Exceptional written and verbal communication skills including excellent skills in English grammar, punctuation, and spelling, and ability to clearly communicate complex ideas and concepts EDUCATION & EXPERIENCE REQUIREMENTS • A Bachelor’s Degree in a Human Service field and two years of experience in the field of mental health, intellectual and developmental disabilities, or substance use disorders is required. OR • A Bachelor’s Degree in a field other than Human Services and six years of experience in the field of mental health, intellectual and developmental disabilities, or substance use disorders is required. Meeting the criteria of being a North Carolina Qualified professional in 10A NCAC 27G .0104 is preferred. Licensure/Certification Required: • CLEAR/NCIT Basic Certified Investigator (certification should be completed within the first 9 months of employment) Preferred work experience: • Three or more years experience in the field of mental health, intellectual and developmental disabilities, or substance use disorders is preferred. • Meeting the criteria of being a North Carolina Qualified professional in 10A NCAC 27G .0104 is preferred. 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: May live in Vaya's catchment area in North Carolina or within 40 miles of the North Carolina border. However, there is a preference for the Charlotte 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.