Competitive Compensation & Benefits Package!
Position eligible for –
- Annual incentive bonus plan
- Medical, dental, and vision insurance with low deductible/low cost health plan
- Generous vacation and sick time accrual
- 12 paid holidays
- State Retirement (pension plan)
- 401(k) Plan with employer match
- Company paid life and disability insurance
- Wellness Programs
See attachment for additional details.
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Office Location: * Flexible for any of our office locations but primarily Remote
Projected Hiring Range: Depending on Experience
Closing Date: Open Until Filled
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Primary Purpose of Position: *
This position assists in the development and management of the provider network for Tailored Care Management. The Clinical Support Specialist is responsible for developing, maintaining and providing quality training and technical assistance to support high performing TCM providers. This position is expected to build and sustain strong working relationships with cross functional departments and assigned TCM providers. The Clinical Support Specialist helps assigned TCM providers operate successfully by providing strategic education on the special needs of members, comprehensive understanding of the contracts (Tailored Plan and Medicaid Direct) and quality initiatives. The Clinical Support Specialist ensures timely submission of routine and ad hoc reporting by assigned TCM providers and reviews performance dashboard data with providers. For providers using TruCare, this position will act as an interface between the provider and Partners staff regarding questions/issues related to TruCare. This position has a critical role in performance monitoring of TCM providers.
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Role and Responsibilities: *
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Orientation/Ongoing Training and Technical Assistance for TCM Providers*
- Conducting new TCM provider orientations and ongoing education to assigned TCM providers and their staff regarding TCM, eligibility, Tailored Plan and Medicaid Direct contract requirements, care management platform (as applicable), TCM data requirements, any other questions impacting provider performance.
- Educating assigned TCM providers on requirements related to special populations (e.g. Transitions to Community Living, NC Innovations, Long-Term Services and Supports, etc)
- Assisting Operations Manager in needed training and/or consultation related to TCM provider use of TruCare.
- Developing and/or supporting development of training modules to address TCM training needs
- Assisting with identifying & developing TCM provider training to meet TCM provider needs.
- Conducting TCM provider meetings to share and discuss issues of concern, troubleshoots for issue resolution, and implements an escalation process for discrepancies.
- Handling or ensuring appropriate scheduling, agenda, materials, location, of TCM provider meetings as needed.
- Serving as a resource to other departments within the organization on TCM provider-related issues.
- Coordinating meetings with assigned TCM providers and internal staff
- Participating in Provider Forums as requested and providing technical support and assistance to Provider Council as needed
- Participating in internal workgroups that involve TCM providers.
- Collaborating with all levels of the organization including Executive Leadership Team, Departmental Directors, and Managers to assist with problem resolution.
- Actively participating with subgroups/initiatives to further network development and adequacy for Tailored Care Management.
- Enhancing relationships with TCM providers by investigating, documenting, and resolving TCM provider matters.
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Performance Monitoring/Reporting*
- Participating in monthly TCM Quality Monitoring Committee
- Monitoring TCM provider performance data and provider operationalization of all contract requirements closely, ensuring provision of appropriate training/technical assistance as needed.
- Collaborating with other departments, including IT, to ensure provider data is collected to support performance monitoring and reporting.
- Overseeing identified performance measures with assigned TCM providers.
- Collaborating with Operations Manager to identify business requirements, needed reports to monitor and track performance.
- Assisting in development of TCM dashboards.
- Providing information and status updates for TCM providers regarding performance and how to maximize their performance.
- Assisting with required internal and external data tracking and performance reporting.
- Regularly meeting with other internal departments to create, revise and adjust strategy for TCM providers.
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Other*
- Participating in internal and external committees, as assigned.
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Knowledge, Skills and Abilities: *
- Considerable knowledge of the policies and contractual requirements related to TCM
- Strong data management/analysis skills
- Exceptional interpersonal and communication skills
- Strong problem solving, negotiation, arbitration, and conflict resolution skills
- Excellent computer skills and proficiency in Microsoft Office products (such as Word, Excel, Outlook, and PowerPoint)
- Demonstrated ability to verify documents for accuracy and completeness; to understand and apply laws, rules and regulations to various situations; to apply regulations and policies
- Ability to make prompt independent decisions based upon relevant facts
- Ability to establish rapport and maintain effective and collaborative working relationships
- Ability to act with tact and diplomacy in all situations
- Ability to maintain strict confidentiality in all areas of work
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Education/Experience Required: *
Bachelor’s Degree and two (2) years of experience in provider network management, health care insurance or other BH/IDD/TBI healthcare delivery setting. MUST reside in North Carolina or within 40 miles of the NC border. Must have ability to travel.
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Education/Experience Preferred: *
Consultation and quality management experience preferred. Care Management experience preferred.
Job Type: Full-time