Provider Network Service Development Specialist

Role Description

The Provider Network Service Development Specialist supports the development and management of the Provider Network, including:

• Assisting with the expansion of current services
• Development of new services
• Recruiting providers to fulfill network needs

This position will assist with Alliance’s networks gaps and needs analysis to help ensure Alliance Health has an adequate provider network. It will also assist in the coordination of cross-departmental initiatives and oversee Provider Network activities related to special initiatives, focusing on:

• Network adequacy
• Current services expansion
• New service implementation

This position is full-time remote. Selected candidate must reside in North Carolina and be willing to travel to one of the offices for business or onsite team meetings as needed. Occasional provider site visits may be required within a 100-mile radius of Alliance home office.

Responsibilities & Duties

• Expand Current Services Network
  • Assess current network adequacy and recommend expansion of current services to address gaps in the service array
  • Research current services that need expansion
  • Assist in recruiting and retaining qualified and capable providers to assist in the expansion of current services
  • Analyze funding incentives and disincentives for best practices
• Identify New Services
  • Identify and recommend new services and supports to address gaps in the service array
  • Research new services identified
  • Assist in recruiting and retaining qualified and capable providers to provide new services
  • Analyze funding incentives and disincentives for best practices
• Oversee Activities Related To New Service Implementation And Current Services Expansion
  • Review and approve the addition of new services to existing providers
  • Develop Scopes of Work (SOW) and lead the process to finalize the SOW and gain approval
  • Ensure all programs, services, and systems are developed in accordance with Local, State and Federal Performance Standards, and congruent with Alliance organizational and procedure manuals
  • Assist in the identification and coordination of internal and external training needs as it relates to new service development and or current service expansion
  • Develop and lead new Provider Collaboratives related to new service, current service expansion or pilot project implementation
• Provide Technical Assistance And Customer Service To Network Providers
  • Ensure that Evidence Based and Best Practice services for consumers are in place as identified and are available for consumers
  • Assist, guide and support providers in the development and maintenance of comprehensive, outcome focused consumer services
  • Be knowledgeable of assigned provider contracts with agencies and organizations in conjunction with Alliance’s Finance and Contract departments
  • Provide technical assistance and feedback for the use of local and state funds, new service delivery and adherence to best practice standards and contractual requirements
• Internal and External Collaboration
  • Collaborate directly with Alliance Health Provider Network Leadership to review network adequacy data to help identify and expand current services
  • Arrange and facilitate interdepartmental, provider and State personnel workgroups
  • Represent Alliance on State Committees, as applicable
  • Assist in the coordination of cross-departmental Initiatives as identified
  • Establish and maintain relationships and collaborations with relevant public, private, and provider agencies
  • Participate in the creation of and attend and or lead newly created Provider Learning Collaboratives
• Out Of Network (OON) Review
  • Evaluate Out of Network requests based on Network capacity and approve or deny requests
• Collaborate with Internal Departments To Develop Solutions To Identified Needs
  • Partner with Health Care Project Management Team, Claims, Business Operations, Medical Management, and other areas to address ongoing needs and develop solutions

Qualifications

• Bachelor’s degree in a Human Services field from an accredited college or university and five (5) years progressive post-degree experience in the field of Mental Health, Substance Use, Intellectual/Developmental Disabilities or Physical Health; or
• Master’s degree in Human Services from an accredited college or university with three (3) years post graduate experience in the field of Mental Health, Substance Use, Intellectual/Developmental Disabilities or Physical Health.

Requirements

• Previous Provider Network experience
• Previous Project Management experience
• Previous Network Adequacy analysis experience and development of new services and programs
• Licensure and/or certification in area served is preferred

Knowledge, Skills, & Abilities

• Knowledge of Alliance’s goals, targets, and outcomes in relation to the responsibilities of the Provider Network Operations department
• Knowledge of all disability areas including Mental Health, Substance Use and Developmental/Intellectual Disabilities
• Knowledge and understanding of principles, concepts, and Best Practices used in the treatment, habilitation and support of individuals with needs in any of the disability areas
• Knowledge and understanding of the different systems that impact Providers
• Proficient with Microsoft Office suite, including Excel
• Proficient with database maintenance
• Exceptional interpersonal skills
• Highly effective communication skills
• Problem-solving skills
• Organizing skills
• Conflict resolution skills
• Effective public speaking and training skills
• Strong mediation skills in order to facilitate collaboration and positive relationships
• High level of diplomacy and discretion to effectively negotiate and resolve issues independently
• Ability to build relationships
• Ability to make prompt decisions based upon relevant facts
• Ability to review and analyze data in an effort to evaluate program effectiveness, progress, problems, and system performance
• Ability to work effectively with others internally and externally
• Ability to effectively identify problems, and initiate solutions
• Ability to take initiative and utilize critical thinking

Salary Range

$69,592-$88,729/Annually. Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity.

Employment for this position is contingent upon a satisfactory background check, which will be performed after acceptance of an offer of employment and prior to the employee's start date.