Vaya Health

The Care Manager - LP is responsible for providing proactive intervention and coordination of care to eligible Vaya Health members to ensure they receive appropriate assessment and services. This role involves working with members and care teams to identify care gaps and facilitate access to necessary services across various health domains. | Candidates must have a Master's degree in a relevant field and meet specific experience requirements related to behavioral health and long-term services and supports. Licensure as a healthcare professional in North Carolina is also required. | LOCATION:  Remote – must live in or near Rockingham County, North Carolina. The person in this position is required to maintain residency in North Carolina or within 40 miles of the NC border.  This position requires travel. GENERAL STATEMENT OF JOB The Care Manager Licensed Professional (“Care Manager - LP”) is responsible for providing proactive intervention and coordination of care to eligible Vaya Health members and recipients (“members”) to ensure that these individuals receive appropriate assessment and services. The Care Manager - LP works with the member and care team to identify and alleviate inappropriate levels of care or care gaps through assessment, multidisciplinary team care planning, linkage and/or coordination of services needed by the member across the MH, SU, intellectual/ developmental disability (“I/DD”), traumatic brain injury (“TBI”) physical health, pharmacy, long-term services and supports (“LTSS”) and unmet health-related resource needs networks. Care Manager - LP supports and may provide clinical transition planning assistance to state, and community hospitals and residential facilities and track individuals discharged from facility settings to ensure they follow up with aftercare services and receive needed assistance to prevent further hospitalization. This is a mobile position with work done in a variety of locations, including members’ home communities. The Care Manager - LP also works with other Vaya staff, members, relatives, caregivers/ natural supports, providers, and community stakeholders. The Care Manager - LP also utilizes licensed clinical knowledge and skills to assess needs, inform care planning development, provide clinical consultation, and offer recommendations for appropriate care.   As further described below, essential job functions of the Care Manager - LP includes, but may not be limited to: * Utilization of and proficiency with Vaya’s Care Management software platform/ administrative health record (“AHR”) * Outreach and engagement * Compliance with HIPAA (Health Insurance Portability and Accountability) requirements, including Authorization for Release of Information (“ROI”) practices * Performing Health Risk Assessments (HRA): a comprehensive bio-psycho-social assessment addressing social determinants of health, mental health history and needs, physical health history and needs, activities of daily living, access to resources, and other areas to ensure a whole person approach to care * Adherence to Medication List and Continuity of Care processes * Participation in interdisciplinary care team meetings, comprehensive care planning, and ongoing care management * Transitional Care Management * Diversion from institutional placement   This position is required to meet NC (North Carolina) Residency requirements as defined by the NC Department of Health and Human Services (“NCDHHS” or “Department”).   This position is required to live in or near the counties served to effectively deliver in-person contacts with members and their care teams.     ESSENTIAL JOB FUNCTIONS Clinical Assessment, Care Planning, and Interdisciplinary Care Team: * Ensures identification, assessment, and appropriate person-centered care planning for members.  * Links members with appropriate and necessary formal/ informal services and supports across all health domains (i.e., medical, and behavioral health home) * Meets with members to conduct the HRA and gather information on their overall health, including behavioral health, developmental, medical, and social needs.  * Administers the PHQ-9, GAD, CRAFT, ACES, LOCUS/CALOCUS, and other screenings based on member’s needs. The Care Manager - LP uses these screenings to provide specific education and self-management strategies as well as linkage to appropriate therapeutic supports.  1. The assessment process includes reviewing and transcribing member’s current medication and entering information into Vaya’s Care Management platform, which triggers the creation of a multisource medication list that is shared back with prescribers to promote integrated care. * Supports the care team in development of a person-centered care plan (“Care Plan”) to help define what is important to members for their health and prioritize goals that help them live the life they want in the community of their choice. 1. Ensure the Care Plan includes specific services to address mental health, substance use, medical and social needs as well as personal goals 2. Ensure the Care Plan includes all elements required by NCDHHS 3. Use information collected in the assessment process to learn about member's needs and assist in care planning 4. Ensure members of the care team are involved in the assessment as indicated by the member/LRP and uses clinical skills to evaluate and incorporate other available clinical information into the assessment as necessary 5. Work with members to identify barriers and help resolve dissatisfaction with services or community-based interventions * Uses clinical skills and expertise to review clinical assessments conducted by providers to ensure all areas of the member’s needs are addressed. Care Manager - LP reviews for clinical accuracy and may provide consultation and technical support to providers as needed based on reviews. * Interprets and analyzes clinical assessments to draw clinical conclusions to support care management activities. * Engages with provider clinical staff to determine clinical appropriateness and course of action when assessments present a wide array of treatment options and members present with complex needs. * Helps members refine and formulate treatment goals, identifying interventions, measurements, and barriers to the goals * Ensures that member/legally responsible person (“LRP”) is/are informed of available services, referral processes (e.g., requirements for specific service), etc. * Provides information to member/LRP regarding their choice of service providers, ensuring objectivity in the process * Works in an integrated care team including, but not limited to, an RN and pharmacist along with the member to address needs and goals in the most effective way ensuring that member/LRP could decide who they want involved  * Supports and may facilitate care team meetings where member Care Plan is discussed and reviewed * Solicits input from the care team and monitor progress * Ensures that the assessment, Care Plan, and other relevant information is provided to the care team  * Reviews assessments conducted by providers and consult with clinical staff as needed to ensure all areas of the member’s needs are addressed * Provide clinical assessment in situations where the member’s lack of clinical home or available network provider creates significant risk to member well-being (e.g., need for time sensitive placement/ discharge from inpatient setting) * Updates Care Plans and Care Management assessment at a minimum of annually or when there is a significant life change for the member * Supports and assists with education and referral to prevention and population health management programs. * Works with the member/LRP and care team to ensure the development of a Care Management Crisis Plan for the member that is tailored to their needs and desires, which is separate and complementary to the behavioral health provider’s crisis plan 1. Ensures the crisis plan includes problem definition, physical/cognitive limitations, health risks/concerns, medication alerts, baseline functioning, signs/symptoms of crisis (triggers), de-escalation techniques.  2. Provides crisis intervention, coordination, and care management if needed while with members in the community. * Supports Transitional Care Management responsibilities for members transitioning between levels of care * Coordinates Diversion efforts for members at risk of requiring care in an institutional setting * Consults with care management licensed professionals, care management supervisors, and other colleagues as needed to support effective and appropriate member care.   Collaboration, Coordination, Documentation: * Utilizes advanced knowledge in their work which requires use of their advanced degree and licensure to be able to participate and initiate independent decisions with matters of significance and drive positive clinical outcomes for Vaya members. * Executes independent discretion and engages in business decisions for the Vaya Care Management Department that support initiatives to promote Vaya’s integrated, whole-person care model for members. * Serves as a collaborative partner in identifying system barriers through work with community stakeholders.   * Manages and facilitates Child/Adult High-Risk Team meetings in collaboration with DSS, DJJ, CCNC, school systems, and other community stakeholders as appropriate.  * Works in partnership with other Vaya departments to identify and address gaps in services/ access to care within Vaya’s catchment. * Participates in cross-functional clinical and non-clinical meetings and other projects as needed/ requested to support the department and organization. * Participates in routine multidisciplinary huddles including RN, Pharmacist, M.D. to present complex clinical case presentation and needs, providing support to other CMs (Care Manager) and receiving support and feedback regarding CM interventions for clients’ medical, behavioral health, intellectual /developmental disability, medication, and other needs. * Participates in other high risk multidisciplinary complex case staffing as needed to include Vaya CMO/ Deputy CMO, Utilization Management, Provider Network, and Care Management leadership to address barriers, identify need for specialized services to meet client needs within or outside the current behavioral health system. * Monitors provision of services to informally measure quality of care delivered by providers and identify potential non-compliance with standards. * Ensures the health and safety of members receiving care management, recognize and report critical incidents, and escalate concerns about health and safety to care management leadership as needed. * Supports problem-solving and goal-oriented partnership with member/LRP, providers, and other stakeholders. * Promotes member satisfaction through ongoing communication and timely follow-up on any concerns/issues. * Supports and assists members/families on services and resources by using educational opportunities to present information. * Verifies member’s continuing eligibility for Medicaid, and proactively responds to a member’s planned movement outside Vaya’s catchment area to ensure changes in their Medicaid county of eligibility are addressed prior to any loss of service. * Proactively and timely creates and monitors documentation within the AHR to ensure completeness, accuracy and follow through on care management tasks. * Maintains electronic AHR compliance and quality according to Vaya policy. * Ensures all clinical and non-clinical documentation (e.g. goals, plans, progress notes, etc.) meet all applicable federal, state, and Vaya requirements, including requirements within Vaya’s contracts with NCDHHS. * Participates in all required Vaya/ Care Management trainings and maintains all required training proficiencies. * Participates in Vaya committees, workgroups, and other efforts that require clinical knowledge, as requested, and identified.   Other duties as assigned. KNOWLEDGE, SKILLS, & ABILITIES * Ability to express ideas clearly/concisely and communicate in a highly effective manner * Ability to drive and sit for extended periods of time (including in rural areas) * Exceptional interpersonal skills and ability to represent Vaya in a professional manner * Ability to initiate and build relationships with people in an open, friendly, and accepting manner * Strong attention to detail and superior organizational skills * Ability to make prompt independent decisions based upon relevant facts. * Well-developed capabilities in problem solving, negotiation, arbitration, and conflict resolution, including a high level of diplomacy and discretion to effectively negotiate and resolve issues with minimal assistance. * A result and success-oriented mentality, conveying a sense of urgency and driving issues to closure * Comfort with adapting and adjusting to multiple demands, shifting priorities, ambiguity, and rapid change * Thorough knowledge of standard office practices, procedures, equipment, and techniques and intermediate to advanced proficiency in Microsoft office products (Word, Excel, Power Point, Outlook, Teams, etc.), and Vaya systems, to include the care management platform, data analysis, and secondary research * Must be highly skilled at shifting between macro and micro level planning, maintaining both the big picture, and seeing that the details are covered. * Ability to use higher-level clinical training and licensure to perform clinical assessments, drive positive outcomes for members, support care management colleagues, and offer clinical assistance to providers. * Highly skilled at performing clinical assessments of members and identifying member needs. * Extensive understanding of the Diagnostic and Statistical Manual of Mental Disorders (current version) within their scope and have considerable knowledge of the MH/SU/IDD/TBI service array provided through the network of Vaya providers.  * Experience and knowledge of the NC Medicaid program, NC Medicaid Transformation, Tailored Plans, state-funded services, and accreditation requirements are preferred. * Ability to complete and maintain all trainings and proficiencies required by Vaya, however delivered, including but not limited to the following: * BH I/DD Tailored Plan eligibility and services  * Whole-person health and unmet resource needs (ACEs, trauma-informed care, cultural humility)  * Community integration (independent living skills; transition and diversion, supportive housing, employment, etc.) * Components of Health Home Care Management (Health Home overview, working in a multidisciplinary care team, etc.)  * Health promotion (common physical comorbidities, self-management, use of IT, care planning, ongoing coordination)  * Other care management skills (transitional care management, motivational interviewing, person-centered needs assessment and care planning, etc.)  * Serving members with I/DD or TBI (understanding various I/DD and TBI diagnoses, HCBS, Accessing assistive technologies, etc.)  * Serving children (child-and family-centered teams, Understanding the “System of Care” approach) * Serving pregnant and postpartum women with SUD or with SUD history  * Serving members with LTSS needs (Coordinating with supported employment resources  * Job functions with higher consequences of error may be identified, and proficiency demonstrated and measured through job simulation exercises administered by the supervisor where a minimum threshold is required of the position.     EDUCATION & EXPERIENCE REQUIREMENTS Master’s degree in a field related to health, psychology, sociology, social work, nursing or another relevant human services area. For incumbents with a Master’s Degree in a Human Services Area besides Nursing, one of the following required years of experience: * Serving members with BH conditions: 1. Two (2) years of experience working directly with individuals with BH conditions * Serving members with LTSS needs 1. Two (2) years of prior Long-tern Services and Supports and/or Home Community Based Services coordination, care delivery monitoring and care management experience. 2. This experience may be concurrent with the two years of experience working directly with individuals with BH conditions, an I/DD, or a TBI, described above   For incumbents with a Master’s Degree in Nursing, four years of full-time accumulated experience in mental health with the population served is required. Experience can be before or after obtaining RN licensure.   *Must meet the criteria of being a North Carolina Qualified Professional with the population served in 10A NCAC 27G .0104   Licensure/Certification Required: Valid licensure required. Acceptable licenses are Registered Nurse (RN), Licensed Clinical Social Worker (LCSW), Licensed Clinical Social Worker Associate (LCSWA), Licensed Clinical Mental Health Counselor (LCMHC), Licensed Clinical Mental Health Counselor Associate (LCMHCA), Licensed Clinical Mental Health Counselor Supervisor (LCMHCS), Licensed Psychological Associate (LPA), Health Services Professional Psychological Associate (HSP-PA), Licensed Clinical Addiction Specialist (LCAS), Licensed Clinical Addiction Specialist Associate (LCASA), Licensed Marriage and Family Therapist (LMFT) or Licensed Marriage Family Therapist Associate (LMFTA).   *Due to the multi-disciplinary nature of the LME/MCO business, care managers must operate within their scope of practice, and must engage and leverage other disciplines outside of their own training and credentials.   Preferred Work Experience: * Experience working directly with individuals with I/DD or TBI      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.  * Ability to drive and sit for extended periods of time (including in rural areas)   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 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.

The Care Manager is responsible for providing proactive intervention and coordination of care to eligible Vaya Health members to ensure they receive appropriate assessment and services. This includes conducting health risk assessments, developing care plans, and coordinating services across various health domains. | A Bachelor's degree in a relevant field is required, along with two years of experience working directly with individuals with behavioral health conditions. Candidates must also meet North Carolina Qualified Professional criteria and have experience in long-term services and supports. | OCATION:  Remote – must live in or near Haywood County, North Carolina. The person in this position must maintain residency in North Carolina or within 40 miles of the North Carolina border. This position requires travel. GENERAL STATEMENT OF JOB The Care Manager is responsible for providing proactive intervention and coordination of care to eligible Vaya Health members and recipients (“members”) to ensure that these individuals receive appropriate assessment and services. The Care Manager works with the member and care team to alleviate inappropriate levels of care or care gaps through assessment, multidisciplinary team care planning, linkage and/or coordination of services needed by the member across the MH, SU, intellectual/ developmental disability (“I/DD”), traumatic brain injury (“TBI”) physical health, pharmacy, long-term services and supports (“LTSS”) and unmet health-related resource needs networks. Care Managers support and may provide transition planning assistance to state, and community hospitals and residential facilities and track individuals discharged from facility settings to ensure they follow up with aftercare services and receive needed assistance to prevent further hospitalization. This is a mobile position with work done in a variety of locations, including members’ home communities. The Care Manager also works with other Vaya staff, members, relatives, caregivers/ natural supports, providers, and community stakeholders. As further described below, essential job functions of the Care Manager include, but may not be limited to: * Utilization of and proficiency with Vaya’s Care Management software platform/ administrative health record (“AHR”) * Outreach and engagement * Compliance with HIPAA requirements, including Authorization for Release of Information (“ROI”) practices * Performing Health Risk Assessments (HRA): a comprehensive bio-psycho-social assessment addressing social determinants of health, mental health history and needs, physical health history and needs, activities of daily living, access to resources, and other areas to ensure a whole person approach to care * Adherence to Medication List and Continuity of Care processes * Participation in interdisciplinary care team meetings, comprehensive care planning, and ongoing care management * Transitional Care Management * Diversion from institutional placement This position is required to meet NC Residency requirements as defined by the NC Department of Health and Human Services (“NCDHHS” or “Department”).  This position is required to live in or near the counties served to effectively deliver in-person contacts with members and their care teams. ESSENTIAL JOB FUNCTIONS Assessment, Care Planning, and Interdisciplinary Care Team: * Ensures identification, assessment, and appropriate person-centered care planning for members.  * Links members with appropriate and necessary formal/ informal services and supports across all health domains (i.e., medical, and behavioral health home) * Meets with members to conduct the HRA and gather information on their overall health, including behavioral health, developmental, medical, and social needs.  * Administer the PHQ-9, GAD, CRAFT, ACES, LOCUS/CALOCUS, and other screenings within their scope based on member’s needs. The Care Manager uses these screenings to provide specific education and self-management strategies as well as linkage to appropriate therapeutic supports.  * The assessment process includes reviewing and transcribing member’s current medication and entering information into Vaya’s Care Management platform, which triggers the creation of a multisource medication list that is shared back with prescribers to promote integrated care. * Supports the care team in development of a person-centered care plan (“Care Plan”) to help define what is important to members for their health and prioritize goals that help them live the life they want in the community of their choice. * Ensure the Care Plan includes specific services to address mental health, substance use, medical and social needs as well as personal goals * Ensure the Care Plan includes all elements required by NCDHHS * Use information collected in the assessment process to learn about member's needs and assist in care planning * Ensure members of the care team are involved in the assessment as indicated by the member/LRP and that other available clinical information is reviewed and incorporated into the assessment as necessary * Work with members to identify barriers and help resolve dissatisfaction with services or community-based interventions * Reviews clinical assessments conducted by providers and partners with Care Manager - LP and Care Manager Embedded - LP for clinical consultation as needed to ensure all areas of the member’s needs are addressed. Help members refine and formulate treatment goals, identifying interventions, measurements, and barriers to the goals * Ensures that member/legally responsible person (“LRP”) is/are informed of available services, referral processes (e.g., requirements for specific service), etc. * Provides information to member/LRP regarding their choice of service providers, ensuring objectivity in the process * Works in an integrated care team including, but not limited to, an RN (Registered Nurse) and pharmacist along with the member to address needs and goals in the most effective way ensuring that member/LRP have the opportunity to decide who they want involved  * Supports and may facilitate care team meetings where member Care Plan is discussed and reviewed * Solicits input from the care team and monitor progress * Ensures that the assessment, Care Plan, and other relevant information is provided to the care team  * Reviews assessments conducted by providers and consults with clinical staff as needed to ensure all areas of the member’s needs are addressed * Updates Care Plans and Care Management assessment at a minimum of annually or when there is a significant life change for the member * Supports and assists with education and referral to prevention and population health management programs. * Works with the member/LRP and care team to ensure the development of a Care Management Crisis Plan for the member that is tailored to their needs and desires, which is separate and complementary to the behavioral health provider’s crisis plan. * Provides crisis intervention, coordination, and care management if needed while with members in the community. * Supports Transitional Care Management responsibilities for members transitioning between levels of care * Coordinates Diversion efforts for members at risk of requiring care in an institutional setting * Consults with care management licensed professionals, care management supervisors, and other colleagues as needed to support effective and appropriate member care.   Collaboration, Coordination, Documentation: * Serves as a collaborative partner in identifying system barriers through work with community stakeholders.   * Manages and facilitates Child/Adult High-Risk Team meetings in collaboration with DSS, DJJ, CCNC, school systems, and other community stakeholders as appropriate.  * Works in partnership with other Vaya departments to identify and address gaps in services/ access to care within Vaya’s catchment. * Participates in cross-functional clinical and non-clinical meetings and other projects as needed/ requested to support the department and organization. * Participates in routine multidisciplinary huddles including RN, Pharmacist, M.D. to present complex clinical case presentation and needs, providing support to other CMs (Care Manager) and receiving support and feedback regarding CM interventions for clients’ medical, behavioral health, intellectual /developmental disability, medication, and other needs. * Works with Care Manager - LP and Care Manager Embedded - LP in participating in other high risk multidisciplinary complex case staffing as needed to include Vaya CMO/ Deputy CMO, Utilization Management, Provider Network, and Care Management leadership to address barriers, identify need for specialized services to meet client needs within or outside the current behavioral health system. * Monitors provision of services to informally measure quality of care delivered by providers and identify potential non-compliance with standards. * Ensures the health and safety of members receiving care management, recognize and report critical incidents, and escalate concerns about health and safety to care management leadership as needed. * Supports problem-solving and goal-oriented partnership with member/LRP, providers, and other stakeholders. * Promotes member satisfaction through ongoing communication and timely follow-up on any concerns/issues. * Supports and assists members/families on services and resources by using educational opportunities to present information. * Verifies member’s continuing eligibility for Medicaid, and proactively responds to a member’s planned movement outside Vaya’s catchment area to ensure changes in their Medicaid county of eligibility are addressed prior to any loss of service. * Proactively and timely creates and monitors documentation within the AHR to ensure completeness, accuracy and follow through on care management tasks. * Maintains electronic AHR compliance and quality according to Vaya policy. * Works with Care Manager - LP and Care Manager Embedded - LP to ensure all clinical and non-clinical documentation (e.g. goals, plans, progress notes, etc.) meet all applicable federal, state, and Vaya requirements, including requirements within Vaya’s contracts with NCDHHS. * Participates in all required Vaya/ Care Management trainings and maintains all required training proficiencies. Other duties as assigned. KNOWLEDGE, SKILLS, & ABILITIES * Ability to express ideas clearly/concisely and communicate in a highly effective manner * Ability to drive and sit for extended periods of time (including in rural areas) * Effective interpersonal skills and ability to represent Vaya in a professional manner * Ability to initiate and build relationships with people in an open, friendly, and accepting manner * Attention to detail and satisfactory organizational skills * Ability to make prompt independent decisions based upon relevant facts. * Well-developed capabilities in problem solving, negotiation, arbitration, and conflict resolution, including a high level of diplomacy and discretion to effectively negotiate and resolve issues with minimal assistance. * A result and success-oriented mentality, conveying a sense of urgency and driving issues to closure * Comfort with adapting and adjusting to multiple demands, shifting priorities, ambiguity, and rapid change * Thorough knowledge of standard office practices, procedures, equipment, and techniques and intermediate to advanced proficiency in Microsoft office products (Word, Excel, Power Point, Outlook, Teams, etc.), and Vaya systems, to include the care management platform, data analysis, and secondary research * Understanding of the Diagnostic and Statistical Manual of Mental Disorders (current version) within their scope and have considerable knowledge of the MH/SU/IDD/TBI service array provided through the network of Vaya providers.  * Experience and knowledge of the NC Medicaid program, NC Medicaid Transformation, Tailored Plans, state-funded services, and accreditation requirements are preferred. * Ability to complete and maintain all trainings and proficiencies required by Vaya, however delivered, including but not limited to the following: * BH I/DD Tailored Plan eligibility and services  * Whole-person health and unmet resource needs (ACEs, trauma-informed care, cultural humility)  * Community integration (independent living skills; transition and diversion, supportive housing, employment, etc.) * Components of Health Home Care Management (Health Home overview, working in a multidisciplinary care team, etc.)  * Health promotion (common physical comorbidities, self-management, use of IT, care planning, ongoing coordination)  * Other care management skills (transitional care management, motivational interviewing, person-centered needs assessment and care planning, etc.)  * Serving members with I/DD or TBI (understanding various I/DD and TBI diagnoses, HCBS, Accessing assistive technologies, etc.)  * Serving children (child-and family-centered teams, Understanding the “System of Care” approach) * Serving pregnant and postpartum women with SUD or with SUD history  * Serving members with LTSS needs (Coordinating with supported employment resources  * Job functions with higher consequences of error may be identified, and proficiency demonstrated and measured through job simulation exercises administered by the supervisor where a minimum threshold is required of the position.   EDUCATION & EXPERIENCE REQUIREMENTS Bachelor’s degree required, preferably in a field related to health, psychology, sociology, social work, nursing or another relevant human services area. * Serving members with BH conditions: 1. Two (2) years of experience working directly with individuals with BH conditions * Serving members with LTSS needs 1. Two (2) years of prior Long-term Services and Supports (LTSS) and/or Home Community Based Services (HCBS) coordination, care delivery monitoring and care management experience. 2. This experience may be concurrent with the two years of experience working directly with individuals with BH conditions, an I/DD, or a TBI, described above --If graduate of a college or university with a Bachelor's degree in Human Services, then incumbent must have two years of full-time accumulated experience in mental health with population served. --If graduate of a college or university with a Bachelor's degree is in field other than Human Services, then incumbent must have four years of full-time accumulated experience in mental health with population served. --If a graduate of a college or university with a Bachelor’s Degree in Nursing and licensed as RN, then incumbent must have four years of full-time accumulated experience in mental health with population served. Experience can be before or after obtaining RN licensure. --If graduate of a college or university with a Master’s level degree in Human Services, although only one year of experience is needed to reach QP status, the incumbent must still have at least two years of full-time accumulated experience in mental health with the population served *Must meet the criteria of being a North Carolina Qualified Professional with the population served in 10A NCAC 27G .0104 Licensure/Certification Required: * If Incumbent has a Bachelor’s degree in nursing and RN, incumbent must be licensed by the North Carolina Board of Nursing to practice in the State of North Carolina.   Preferred work experience: * Experience working directly with individuals with I/DD or TBI   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.  * Ability to drive and sit for extended periods of time (including in rural areas)   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/ [https://www.vayahealth.com/about/careers/].   Vaya Health is an equal opportunity employer.

The Technical Analyst collaborates with stakeholders to define and document business processes and software requirements for various software development initiatives. They ensure that all requirements are documented and met throughout the software development lifecycle. | Candidates should have a high school diploma or an associate or bachelor's degree in a related field, along with relevant experience in supporting business computer systems. Strong analytical, communication, and problem-solving skills are essential. | LOCATION:  Remote – This is a home based, virtual position that operates Monday - Friday from 8:30am-5:00pm EST. Vaya Health welcomes applications from NC, SC, GA, TN, VA, MD, and FL. GENERAL STATEMENT OF JOB The Technical Analyst works with stakeholders from all business units and related third parties to define and document business processes and software requirements for software development initiatives including operational reporting, data warehousing, data analysis, data science, and application development.  Interfaces with various departments and/or functional teams as required to support solution delivery. Proactively identify needs or issues; analyze business processes; develop strategies and propose technical and process solutions; document requirements for proposed solutions; and liaise with the stakeholders throughout the development process. Participates throughout the software development lifecycle by not only gathering and documenting requirements, but also ensures changing requirements are documented, ongoing development is in line with the documented requirements, test plans and testing activities match documented requirements, and the final deliverables fulfill all documented requirements. Perform ad hoc data analysis, perform data extracts to satisfy business department needs, and generate prototypes of software systems. ESSENTIAL JOB FUNCTIONS Requirements Analysis:  * Define the business problem and primary objectives for software development projects by analyzing and modeling the business domain to create a complete picture of workflows and functional and technical requirements fulfilled by existing and proposed solutions. * Identify and validate the business requirements. Requirements Documentation: * Prepare accurate and detailed requirements documents and development specifications; coordinate requirements walkthroughs with stakeholders; and obtain business unit signoff on the requirements documents verifying that use cases, process models, and specifications accurately portray the business needs. Data Analysis and Prototyping: * Pull ad- hoc data from Vaya Health data systems to support business department requests. * Creation of prototype systems and reports as proof of concept prior to formal development. Follow-up Requirements During Development Process: * Collaborate with other teams in MIS during all phases of the development process to ensure that developed products meet business needs. * Participate in product testing to ensure alignment with requirements. Professional Development: * Continue learning and improving upon the skills necessary to stay competitive in the field and coincide with the advances in technology. * Participate in conferences, seminars, certification programs, etc. as applicable to ensure continued skill development and technical competency. Other Duties as Assigned. KNOWLEDGE, SKILLS, & ABILITIES * Strong knowledge and experience in the development of Business Intelligence and reporting solutions * Proven ability to understand business processes and interact directly with internal customers and peers to provide sound business solutions * Strong interpersonal skills including mentoring, coaching, collaborating, and team building * Excellent verbal and written communication skills; the ability to articulate ideas clearly * Proven ability to meet commitments and manage expectations * Proven problem solver, with the ability to understand complex processes and applications * Desire for constant improvement * Must be able to work independently and as a strong team player * Ability to work in a fast-paced, deadline driven environment running multiple projects simultaneously * Must possess the integrity and decision-making skills necessary to work with and protect confidential personal health information EDUCATION & EXPERIENCE REQUIREMENTS * A High School Diploma/GED and six (6) - ten (10) years of experience supporting business computer systems or similar applications OR * An Associate Degree in Information Systems or related business field and four (4) years  of experience supporting business computer systems or similar applications OR * An Associate Degree and six (6) years of experience supporting business computer systems or similar applications OR * A Bachelor’s Degree in Information Systems or related business field and at least two (2) years of related experience analyzing and designing business systems OR * A Bachelor Degree and three (3)– five (5) years of related experience analyzing and designing business systems 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 live in NC, SC, GA, TN, VA, MD, or FL. 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.

Coordinate and support project management office initiatives by organizing meetings, managing documentation, and communicating with stakeholders to ensure project progress. | Requires 1-2 years project support experience, proficiency in Microsoft O365 and Smartsheet, strong communication and organizational skills, and preferably PMP certification. | LOCATION:  Remote – This is a home based, virtual position that operates Monday – Friday from 8:30am-5:00pm (EST). Vaya Health welcomes applications from NC, SC, GA, TN, VA, MD, and FL. GENERAL STATEMENT OF JOB The Project Management Office (PMO) Project Coordinator assists with the process, program, and project development efforts for the PMO initiatives to support the organization moving from current to future state operations. This position coordinates and influences activities and resources in support of one or more highly visible, varying-scale projects with high/medium/low impact, risk, and complexity. ESSENTIAL JOB FUNCTIONS Organizational Support – Provides comprehensive support to assigned individuals and the organization, by being detail-oriented and resourceful in completing projects as assigned. Incumbent will be able to multi-task effectively and utilize organizational knowledge to ensure that projects are being completed in a manner consistent with established objectives. * Provides comprehensive support to assigned individuals and the department, by being detail-oriented and resourceful in completing projects as assigned * Organizing, attending and participating in both internal and external stakeholder meetings * Documentation and follow up on important actions and decisions from meetings * Coordinate activities, resources, equipment and information * On a regular basis, meet with PPMO team members to review progress and to discuss future steps on work tasks/initiatives/projects. Arrange meetings with the members of the PPMO team and other collateral business units. Organize appropriate meeting rooms and any refreshments, contact the attendees and note any who can’t attend. Before the meeting, send out any relevant information, and attend each meeting to take minutes. Documentation Management – Thoroughly and accurately enter and maintain data points in all applicable systems and/or applications as per established practices, processes and protocols. It is essential that all record keeping, and information sharing be timely and well-documented to ensure that all information based upon data points supports the organizational needs for daily operations and reporting requirements * Assists in updating and maintaining project plans, documents and schedules * Helping with the documentation of each phase of the project, as well as making summary reports that will be presented to the organization’s management team * Provide support including document management in Microsoft Teams, Projects, Visio, SharePoint, Smartsheets and/or OneNote, including meeting minutes, supporting documentation, etc.  Communications and Customer Service – Demonstrates courteous, cooperative and collaborative behavior in all interactions with internal and external customers. Presents a positive image and represents the organization in a professional manner during all communications. Being so closely involved in the PPMO, this role is relied upon to identify any potential issues or risks that could affect the progression of the work tasks/initiatives/projects. They communicate these items with the lead, and work to identify potential solutions. KNOWLEDGE OF JOB * A demonstrated knowledge of department program practices/processes and ability to apply knowledge to resolve problems/inquiries, to process information and complete assigned tasks. * This position requires exceptional interpersonal skills, highly effective communication ability, and the propensity to make prompt independent decisions based upon relevant facts and established processes. * Problem solving, negotiation and conflict resolution skills are essential to balance the needs of both internal and external customers. * The employee must be detail oriented, able to independently organize multiple tasks and priorities, and to effectively manage workload under pressure of deadlines. * Proficiency in Microsoft O365 suite including Word, Excel, PowerPoint, Microsoft Teams, WebEx, SharePoint, OneNote and SmartSheet is required.  EDUCATION & EXPERIENCE REQUIREMENTS  High School diploma or GED is required.   Associate degree in Business Administration, Computer Information Systems, Healthcare Administration, or Project Management preferred. * 1-2 years of experience in supporting various projects and initiatives in a professional setting, preferred.   Preferred Licensure/Certification: * PMP Certification 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: The person in this position must live in NC, SC, GA, TN, VA, MD, or FL. 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/ [https://www.vayahealth.com/about/careers/]. Vaya Health is an equal opportunity employer.

Coordinate and support project management office initiatives by organizing meetings, managing documentation, and facilitating communication among stakeholders. | Requires 1-2 years project support experience, proficiency in Microsoft O365 tools, strong communication and organizational skills, and preferably PMP certification. | LOCATION: Remote – This is a home based, virtual position that operates Monday – Friday from 8:30am-5:00pm (EST). Vaya Health welcomes applications from NC, SC, GA, TN, VA, MD, and FL. GENERAL STATEMENT OF JOB The Project Management Office (PMO) Project Coordinator assists with the process, program, and project development efforts for the PMO initiatives to support the organization moving from current to future state operations. This position coordinates and influences activities and resources in support of one or more highly visible, varying-scale projects with high/medium/low impact, risk, and complexity. ESSENTIAL JOB FUNCTIONS Organizational Support – Provides comprehensive support to assigned individuals and the organization, by being detail-oriented and resourceful in completing projects as assigned. Incumbent will be able to multi-task effectively and utilize organizational knowledge to ensure that projects are being completed in a manner consistent with established objectives. • Provides comprehensive support to assigned individuals and the department, by being detail-oriented and resourceful in completing projects as assigned • Organizing, attending and participating in both internal and external stakeholder meetings • Documentation and follow up on important actions and decisions from meetings • Coordinate activities, resources, equipment and information • On a regular basis, meet with PPMO team members to review progress and to discuss future steps on work tasks/initiatives/projects. Arrange meetings with the members of the PPMO team and other collateral business units. Organize appropriate meeting rooms and any refreshments, contact the attendees and note any who can’t attend. Before the meeting, send out any relevant information, and attend each meeting to take minutes. Documentation Management – Thoroughly and accurately enter and maintain data points in all applicable systems and/or applications as per established practices, processes and protocols. It is essential that all record keeping, and information sharing be timely and well-documented to ensure that all information based upon data points supports the organizational needs for daily operations and reporting requirements • Assists in updating and maintaining project plans, documents and schedules • Helping with the documentation of each phase of the project, as well as making summary reports that will be presented to the organization’s management team • Provide support including document management in Microsoft Teams, Projects, Visio, SharePoint, Smartsheets and/or OneNote, including meeting minutes, supporting documentation, etc. Communications and Customer Service – Demonstrates courteous, cooperative and collaborative behavior in all interactions with internal and external customers. Presents a positive image and represents the organization in a professional manner during all communications. Being so closely involved in the PPMO, this role is relied upon to identify any potential issues or risks that could affect the progression of the work tasks/initiatives/projects. They communicate these items with the lead, and work to identify potential solutions. KNOWLEDGE OF JOB • A demonstrated knowledge of department program practices/processes and ability to apply knowledge to resolve problems/inquiries, to process information and complete assigned tasks. • This position requires exceptional interpersonal skills, highly effective communication ability, and the propensity to make prompt independent decisions based upon relevant facts and established processes. • Problem solving, negotiation and conflict resolution skills are essential to balance the needs of both internal and external customers. • The employee must be detail oriented, able to independently organize multiple tasks and priorities, and to effectively manage workload under pressure of deadlines. • Proficiency in Microsoft O365 suite including Word, Excel, PowerPoint, Microsoft Teams, WebEx, SharePoint, OneNote and SmartSheet is required. EDUCATION & EXPERIENCE REQUIREMENTS High School diploma or GED is required. Associate degree in Business Administration, Computer Information Systems, Healthcare Administration, or Project Management preferred. • 1-2 years of experience in supporting various projects and initiatives in a professional setting, preferred. Preferred Licensure/Certification: • PMP Certification 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: The person in this position must live in NC, SC, GA, TN, VA, MD, or FL. 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.

The Physical Health PN Contract Manager is responsible for identifying and contracting with physical health providers to develop a stable provider network. This role involves negotiating contracts, analyzing financial impacts, and maintaining strong relationships with health systems. | A Bachelor's degree in Public Administration, Business, or Human Services is required, with a Master's degree preferred. Candidates should have 2-5 years of relevant network management experience, including contracting with healthcare providers. | LOCATION:  Remote – this is a home based, virtual position that operates Monday – Friday from 8:30am-5:00pm EST. Must live in North Carolina or within 40 miles of the NC border. GENERAL STATEMENT OF JOB The Physical Health PN Contract Manager identifies and contracts with physical health providers to develop the physical health provider network yielding a geographically broad access, stable network that achieves objectives for unit cost performance, and produces an affordable and predictable product for members and business partners. This role evaluates and negotiates contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls.  The Physical Health PN Contract Manager initiates, negotiates, and executes physician, hospital, ancillary and/or other provider contracts and agreements for Vaya Health. This position works on problems of diverse scope and complexity ranging from moderate to complex. Strategically approach the provider community and prioritize network needs both quantitatively and qualitatively. ESSENTIAL JOB FUNCTIONS Network Management: * Responsibilities include establishing and maintaining strong business relationships with Health Systems (Hospital, Physician and Ancillary providers), and ensuring the network composition includes an appropriate distribution of provider specialties. * Negotiate and re-negotiate provider organization contract terms, payment structures, and reimbursement rates to providers.  * Analyzes financial impact of contracts and terms.  * Maintains contracts and documentation within a tracking system.  * Advises executives to develop functional strategies (often segment specific) on matters of significance.  * Function as the single point-of-contact for all on-going contractual and service issues as needed by providers * Facilitate provider education and training to increase provider familiarity and satisfaction with Vaya’s systems and strategies * Create and review trend analyses and summaries for decision-making purposes * Interface with Vaya network and department leaders to align provider development needs and projects * Study and design innovative programs to create and enhance access to care, such as jail diversion, veterans and under-served populations, * Work with provider organizations and community stakeholders to successfully implement new programs and improve member access to care. * Apply network configuration and incentive-based payment models as appropriate to improve quality and efficiency * Assist others to resolve highly complex or unusual business problems that affect major functions or disciplines * Exercises independent judgment and decision making on complex issues   regarding job duties and related tasks, and works under minimal supervision, uses independent judgment requiring analysis of variable factors and determining the best course of action.     KNOWLEDGE, SKILLS, & ABILITIES * Proficiency in analyzing, understanding, and communicating financial trends; strong customer service skills; excellent verbal and written communication skills * Ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand * Ability to understand and interpret complex information from others, including but not limited to reimbursement policy standards; exceptional Business Acumen * Ability to present to varied audiences * Ability to manage multiple priorities in a fast-paced environment; high level of proficiency in Microsoft Office applications; prior demonstrated success in provider relations with large provider groups and/or ancillary providers * Experience with multiple provider relations methodologies such as RVRBS, flat rates, case rates, per diems and tiered rates based on the intensity of service * Expert level of knowledge of CMS reimbursement methodologies     EDUCATION & EXPERIENCE REQUIREMENTS  Bachelor’s degree in Public Administration, Business or Human Services required.  Master’s degree preferred.  Must have 2-5 years of relevant network management experience including contracting with Healthcare Providers and network administration in a healthcare company.   Preferred Experience: * Extensive provider contracting skills, including contract preparation and implementation, financial analysis, and rate proposal development preferred. * Experience with Medicaid and Value Based Contracting utilizing financial modeling in making rate decisions 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: The person in this position must 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.

The Peer Support Specialist is responsible for engaging and educating adults with serious mental illness about community-based mental health services and supported housing options. This includes facilitating in-reach visits, providing information on available services, and coordinating with other staff to ensure smooth transitions for members/recipients. | A high school diploma or GED is required, along with 1-2 years of experience working with the mental health/substance use population. Candidates must also be NC Certified Peer Support Specialists. | LOCATION:  Remote – must live in or near Vance, Franklin, Granville, or Person County, NC.  The person in this role must live in North Carolina or within 40 miles of the North Carolina border. This is a home-based position that requires community travel. GENERAL STATEMENT OF JOB Under the supervision of the Peer Support Specialist Manager, the Peer Support Specialist function is in-reach, engagement, education and support effort designed to accurately and fully inform adults who have serious mental illness (SMI) or a serious and persistent mental illness (SPMI) about community based mental health services and supported housing options including but not limited to the availability of tenancy support services and rental assistance.   Peer Support Specialist in-reach is ongoing with the goal of educating members/recipients about all community-based options, including the option to transition to supported housing, its benefits, the array of services and supports available to those in supported housing to include rental subsidy and other assistance members/recipients may need. In-reach also includes informing members/recipients about Medicaid, Special Assistance, services under the North Carolina State Plan for Medical Assistance or the State funded service array for which the members/recipients are eligible.   Peer Support Specialist in-reach also includes offering the members/recipients opportunities to meet with other members/recipients with disabilities who are living, working, and receiving services in inclusive settings.   Note: This position requires access to and use of confidential healthcare information or protected health information (PHI) as described in laws addressing patient confidentiality, including, but not limited to, the federal HIPAA law, the Confidentiality of Alcohol and Substance Use Patient Records law, 42 CFR Part 2, and various state laws. As such, the individual filling this position shall be required to be trained regarding such laws and shall be required to observe those laws in his/her capacity as an employee of Vaya Health. The individual filling this position shall also sign a confidentiality statement as an employee of Vaya Health. ESSENTIAL JOB FUNCTIONS Benchmarks: Peer Support Specialist In-Reach * Must make minimum in-reach visits per day to meet weekly visit requirements. * Must meet minimum requirements per In Reach, Transition, Diversion policy for potential transition participants per month. * Must make minimum requirements for completion of the Informed Decision-Making Tool per month * Ensure adherence to boundaries within In Reach, Transition, Diversion policy and do not provide services or supports outside of the scope of work. Monitoring * Must maintain caseload (In-Reach List) by ensuring every person has a Peer Support Specialist visit prior to reaching 90 days. Frequency of ivisits can vary within 90 days based on readiness for transition. * Will communicate with manager any upcoming events (if known) that may impact minimum requirements and will propose an alternative plan to ensure that requirements are met.  Peer Support Specialist In-Reach activities: The LME-MCO shall provide In-Reach services to applicable members/recipients no less than quarterly. Peer Support Specialist may need to occur more frequently based on the housing situation of the member/recipient. It is required that Peer Support Specialist activities be delivered by LME-MCO staff that are knowledgeable about community services and supports, including supported housing.   The LME-MCO Peer Support staff is expected to coordinate a face-to-face meeting with members/recipients and guardians as applicable to determine a member/recipient’s interest in integrated supported housing with tenancy rights and behavioral health services. Peer Support Specialist staff should make every effort to schedule visits during a time that is convenient for both the member/recipient and facility. Activities include but are not limited to: * Assessing member/recipient’s interest in supported housing * Explaining fully the benefits and financial aspects of clinically appropriate community based inclusive settings, including supported housing * Facilitating and accompanying member/recipient on site visits to permanent housing with tenancy rights * Exploring and addressing the concerns of any member/recipient who declines the opportunity to move into supported housing or who are ambivalent about moving into supported housing, despite being qualified for such housing * Reviewing housing preferences * Provide linkage to ongoing in-reach as a step-in education/exposure to the housing options and supports available * Educating member/recipient about services covered under the North Carolina State Plan for Medical Assistance, Medicaid 1915(b)(c) waiver, or the State funded service array Documentation and Reporting: All Peer Support Specialist activities should be documented and outcomes of in-reach efforts tracked to include refusals to meet with LME-MCO as well as lack of response to LME-MCO written communication about in-reach by the member/recipient or guardian. All documentation related to Peer Support Specialist in-reach should be made available to the State upon request.   Peer Support Specialist staff will participate in all necessary activities at the NC state level. The activities will include training, information sessions, and committees related to Transitions to Community Living Initiative.   Coordination planning: Peer Support Specialist staff will work in close coordination with other Vaya staff, including but not limited to Transition Coordinators, care management, and other Vaya departments to ensure smooth transitions occur and challenges and barriers to transition are addressed timely.   Other duties as assigned.     KNOWLEDGE, SKILLS, & ABILITIES General knowledge of the methods and principles of recovery and person-centered thinking is needed. Having good customer service skills are essential. The ability to establish appropriate and respectful relationships/partnerships with persons with a wide range of disabilities and their families. Includes the ability to interact professionally and effectively with persons who are upset and who disagree. Building trust, establishing rapport and using good communication skills are key for this position. Knowledge of the laws, regulations, and policies which govern human services is helpful. Knowledge about Medicaid and Special Assistance benefits, available clinical services, community supports, and supported housing is necessary. Is able to express ideas clearly and concisely orally and in writing. The ability to work effectively as a team member and under the direction of the Peer Support Specialist Manager. Additional training is required, which can be obtained after hire, in the following skills set: Assertive Engagement, Motivational Interviewing, Active Listening Skills, RENEW Transition Model, and other relevant methods of engagement. EDUCATION & EXPERIENCE REQUIREMENTS High school diploma or GED is required for this position and 1-2 years of experience working with the MH/SU population.   Licensure/Certification Required: NC Certified Peer Support Specialist     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/ [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.