Manager of Network Services and Supports

SCCMHA JOB VACANCY ANNOUNCEMENT CLASSIFICATION: Manager of Network Services and Supports PAY RANGE: $84,784.41 - $113,711.83 annually POSITION SUMMARY: Under the general supervision of the Executive Director of Network Services, Public Policy, and Enhanced Health Services provides agency leadership of Auditing services and processes both internal and external reviews, Home and Community Based Services Rules, and Credentialing as it relates to the requirements by various regulatory bodies and billing for services provided by SCCMHA and the network providers. This position will be the liaison between SCCMHA and residential providers including community living supports providers as well as provider agencies that provide community inclusion and skill building. Will have knowledge about residential services in general to help individuals obtain a least restrictive setting to live and promote access to the community. This position will be knowledgeable about and actively support culturally competent recovery-based practices; person centered planning as a shared decision-making process with the individual, who defines their life goals and is assisted in developing a unique path toward those goals; and a trauma informed culture of safety to aid persons served in the recovery process. ESSENTIAL DUTIES AND RESPONSIBLITIES: 1) Supervises the Provider Network Auditing Supervisor and the Credentialing Coordinator. Understands Auditing processes and oversees the Auditing Unit and reports any concerns to upper management. 2) Works with Auditing unit on any compliance reviews such as Medicaid Event Verification (MEV) Reviews, and Michigan Department of Health and Human Services (MDHHS) waiver reviews Office of Inspector General (OIG), substantiated office of recipient rights complaints requiring provider sanctions. 3) Oversees audit unit annual plan to meet organizational goals. 4) Reports out audit scores as well as any event verification findings to the upper management and posts annual audit scores on the SCCMHA website. Reports annually any trends that are occurring among the varying provider categories to leadership members. 5) Understands credentialing processes and supervises the Credentialing Coordinator. Provides guidance to the Credentialing Coordinator as new credentialing requirements are implemented by various insurances and governing and regulatory bodies. 6) Is a member of the credentialing committee and is a member of the coding and benefit integrity committee. 7) Understands coding and credentialing and is able to oversee credentialing as it relates to providing billable services according to various insurances including Medicaid, Medicare and commercial insurances, ability to pay and siding fee schedule. This includes knowledge of the verification processes for appropriate billing to these various insurances. Including compliance with healthcare responsibilities for credentialing providers under their licensure. 8) Has knowledge about credentialing for Substance Use Treatment. 9) Assure changes to policies and procedures and develops any procedures related to the Auditing Unit as well as any credentialing policies and procedures. 10) Provides leadership in Home and Community Based Services (HCBS) Rules. Works closely with key directors and supervisors to assure all are informed of any rule/interpretation changes and compliance of rules. 11) Works closely with residential, community living supports, community inclusion, and skill building network providers. 12) Works closely with SCCMHA contracts department as it relates to securing residential placement options for individuals served by Saginaw County Community Mental Health Authority. 13) Works closely with SCCMHA finance department to assure implementation of any credentialing changes are implemented as it relates to billing. 14) Will oversee needs in the area of residential services including specialized residential services, licensed and unlicensed under contract with SCCMHA and will assist SCCMHA with development of new residential settings and assure the new providers are compliant with the HCBS rules as well as SCCMHA standards. 15) Will work with skill building, community living supports providers to assure HCBS compliance and problem solve any concerns. 16) Will work with respite providers to assure compliance with Medicaid manual requirements. 17) Will be the liaison between residential, community living supports, and respite providers and SCCMHA. 18) May serve as liaison to the Mid State Health Network (MSHN) monitoring committees to provide input into the tools used across all of MSHN CMH’s. 19) Will handle confidential materials as it relates to credentialing, and auditing of providers. 20) Performs administrative tasks as assigned by the Executive Director of Network Services, Public Policy, and Enhanced Health Services, which may involve any area of department operations. 21) Will be a member of the Residential Placement Committee, and Residential Watch Committee. 22) Will be a member of one of the QI committees such as accountability. 23) Adheres to the mission, vision, core values, and operating principles of Saginaw County Community Mental Health Authority (SCCMHA) at all times. INCIDENTAL DUTIES AND RESPONSIBILITES: 1. Represents the units or department/department director as requested at internal or provider meetings. 2. Performs various administrative/clerical functions such as preparing travel vouchers, making copies of documents, filing, etc. 3. May participate in fidelity or other quality and audit related functions. 4. Attends meetings, seminars, workshops, and community events related to the public mental health mission and in order to sustain professional competency. 5. Reacts productively to change and handles other essential tasks as assigned. 6. Required to drive to off-site locations. 7. Uses computer hardware and software to perform tasks. (The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all duties and responsibilities required of personnel so classified.) REPORTING RELATIONSHIPS: Reports to: Director of Network Services, Public Policy, Continuing Education, OBRA/PASARR and Enhanced Health Services. Supervises: Provider Network Auditing Supervisor, and Direct Supervision of Credentialing Coordinator WORKING CONDITIONS/ENVIRONMENT: Works in professional managed healthcare office environment with pressures of time constraints, multiple projects, and priorities. Works at computer workstation for long periods of time, which requires extensive viewing of monitor screens. Frequent and continuous use of computer keyboard. Occasionally, will be required to drive personal automobile. Close contact with all service program areas and providers as well as SCCMHA leadership. Occasional contact with the public and in proximity of persons served who may have communicable disease, and who may be hostile, aggressive, and potentially violent. QUALIFICATIONS: Education: Bachelor’s degree in human services or in a business-related area, with specific program or financial auditing experience and at least 5 years’ experience. Master’s degree will be considered with knowledge and experience in business related field or financial auditing experience. Experience: A minimum of five (5) years of experience in health care, business or related financial or program field is required; although clinical experience is helpful, experience must include some business-related functions. Audit and/or data analysis experience preferred. Behavioral health field, physical health care, human service experience, and/or knowledge preferred. Business, finance, and computer skills, including spread sheet functions, are required. A general knowledge of mental health systems, disability supports systems, and compliance or medical records desired. Must be able to provide samples of varied, quality written work. Licenses and Credentials: Valid Michigan Driver’s license with a good driving record. Knowledge, Skills, and Abilities: 1. Knowledge of billing and credentialing processes including Substance Use. 2. Knowledge of AFC Licensing, Health Care credentialing, and health care compliance review process. 3. Ability to prepare professional routine correspondence or analytical reports is essential. 4. Ability to exercise independent, and mature judgment, diplomacy, discretion, interpersonal problem solving and attention to detail abilities are required. 5. Ability to represent the organization in a positive, professional manner. 6. Ability to manage multiple priorities at once. 7. Data base experience. 8. Familiarity with excel and excel spread sheets. 9. Demonstrated accuracy with detailed work. 10. Good communication and interpersonal skills. 11. Ability to learn and explain complex federal and state regulations, and Medicaid regulations. 12. Ability to relate to individuals from all social, cultural, and economic backgrounds. Physical/Mental Requirements: 1. Hearing acuity to converse in person and on telephone. 2. Visual Acuity to read and proofread documents. 3. Ability to walk, stand, or sit for extended periods of time. 4. Manual to write and to operate standard office equipment (PC, Keyboard, Copy Machine, Fax Machine, etc.) 5. Ability to regularly lift and carry files and supplies at least 30 pounds. Ability to reach, bend, or stoop to manage charts or supplies up to 30 pounds. 6. Strong interpersonal skills to interact with leadership, employees, consumers, providers, and the general public. 7. Mental capacity to think independently, follow instruction and use judgment. 8. Ability to use tact and courtesy with others. 9. Ability to plan short and long range and to manage and schedule time. 10. Ability to handle stress in meeting deadlines and dealing with diverse individuals in daily work. 11. Ability to protect confidential documents and information with discretion (Listed qualifications are for guidance in filling this position. Any combination of education and experience that provides the necessary knowledge, skills, and abilities will be considered; however, mandatory licensing or certification requirements cannot be waived. Physical/mental requirements cannot be waived unless specifically indicated.) Employment Type: Full Time