Program Specialist

Program Specialist

Help Program Administration Analyzes and evaluates using both qualitative and quantitative principles working in collaboration with both regional and other medical center community provider specialists to improve the experience of Community Providers associated in providing services to Veterans and support to local VAMC veterans' health care delivery experience. Supports operations in meeting established goals, metrics and objectives. Using regional office guidelines and policy, implements and modifies program policies, regulations, goals, or objectives. Identifies data required for use in the management and direction of programs. Develops program evaluation plans, procedures, and methodology. Works with Office of Community Care (OCC) Regional Program Office to evaluate programs against short and long-range objectives. Develops and maintains positive relationships with local medical center Community Providers and stakeholders, such as hospital associations and affiliates. Provides ongoing education, partners with the OCC and Community Care Network (CCN) Regional staff and serves as a customer service point of contact for problem resolution regarding claims, provider network adequacy, access to care issues, standards of quality health care delivery, and contract relationships. This position works positively and collaboratively with the OCC Provider Relations Office, VISN and VACO representatives to resolve and escalate concerns stemming from community and VA providers. This position will establish regular points of contacts with community hospitals, community specialty and primary care practices and performs regular and reoccurring visits on a scheduled basis to provide education and address concerns. At least 50 percent of the time will be spent traveling and meeting with community provider stakeholders. Investigates and resolves problems and special cases brought to the attention of top management including those from the agency's executive management staff. Gathers facts and resolves conflicts of information or interpretation and develops cases in accordance with applicable policies, procedural manuals, and other guidelines, and coordinates resolution development appropriate operating offices. Monitors trends in provider issues and reports to the Service Chief. Monitors appeals for providers within the assigned region. Communicates quality issues to providers and Quality, Safety, Value (QSV) staff through the chief of Community Care position and helps create action plans to improve quality metrics; remains in contact with provider throughout process. Direction/Long-Range Planning Supports the development of a program for the continued growth in use of data analytics and decision support based on these analytics including: identification of resources available for analysis, identification of gaps in services, identification of data quality, and issues that impact management ability to make informed decisions based on key data metrics associated with these data sets. Provides and assists with establishing and participating in monitoring tools and performance metrics to evaluate Network Capacity (access), community referral processes, provider relationships, and other performance and compliance factors. Analyzes trends for a range of initiatives (e.g: network adequacy, provider complaints, credentialing compliance, referral processing) compared on a National level, identifying markets, where deficiencies or irregularities are identified which may need further investigation to determine anomalies between sites. Recommends corrective action for optimal efficiency within the department and interrelated programs. Makes formal and informal presentations outlining the history, status, and objectives of all functional responsibilities. Quality/Productivity In collaboration with VISN leadership and VACO Regional Community Provider Specialist (CCN) works collaboratively to implement future CCN priorities/programs and help to develop and promote network adequacy in support of local medical center. Develops, maintains, and executes tasks related to project management necessary for the assessment and analysis of projects. Develops complex business strategies that include current Community programs, associated systems and future initiatives. Responsible for managing and integrating the work of assigned teams from different organizations for successful execution of all projects. Ensures that the skills, tools, and people are in place to meet the customer needs for the projects to be executed. Work Schedule: Monday - Friday; 7am-330pm; 730am-4pm; or 8am-430pm Virtual: This is not a virtual position. Position Description/PD#: Program Specialist/ PD013530 Relocation/Recruitment Incentives: Not Authorized Critical Skills Incentive (CSI): Not Approved Permanent Change of Station (PCS): Not Authorized