Responsibilities And Duties:- Ensure programs, services, and systems are provided in accordance company requirements, Local, State and Federal Standards- Conduct routine provider monitoring and post-payment reviews- Using clinical expertise, effectively interpret qualitative and quantitative provider information to appropriately document findings- Review State Plan documents, MCO Business Plan, Provider contracts, Provider Operations Manual, and Clinical Service Guidelines to ensure provider services comply with standards- Review clinical requirements of the service definitions within provider contracts as well as other contractual requirements- Provide reports on outcomes of monitoring and the potential impact on consumers involved to the Provider Network Evaluator Supervisor- Assist in department policies, procedures, and standards- Assist in the development of standards for service monitoring, quality improvement and evaluating the delivery of services to consumers and families- Assist in the development of monitoring policies and procedures pertaining to behavioral health and I-DD services- Provide monitoring information for inclusion in Provider database- Work with Provider Network Team to maintain a provider database which will include information gathered from monitoring activities- Assist in the development of quality indicators and Provider profile elements for the Provider database, in collaboration with the Service Management - Maintain knowledge of current services and supports available- Acquire and maintain knowledge of the current services and supports available within the catchment area and available to consumers within North Carolina- Provide technical assistance to providers, stakeholders and internal departments as requested and needed
1-4 years
This position will require travel within the communities as needed.
Minimum Requirements:- Masters degree from an accredited college or university in a Human Services field (such as Psychology, Social Work, etc.) and a minimum of three (3) years post Masters degree progressive experience in the field of mental health, developmental disabilities or substance abuse. Must maintain a valid drivers license and a good driving record.- Must have a current, active NC license as a LCSW, LCMHC, LPA, or LMFT.- The National Certified Investigator and Inspector Training (NCIT) must be successfully completed within 6-months of hire.- Working knowledge of federal and state statutes, rules, definitions and regulations that govern MHDDSAS services- Knowledge of all disability areas including Mental Health, Developmental Disabilities and Substance Abuse- Thorough Clinical knowledge and understanding of the principles, concepts and Best Practices used in the treatment, habilitation and support of individuals with needs in any of the disability areas- High level of diplomacy and discretion- Mediation skills- Excellent team building skills- Effective communication skills- Ability to identify/analyze administrative problems pertinent to the contract- Ability to make independent judgments, logical conclusions, recommendations and decisions- Ability to determine the appropriate course of action in an emergency or stressful situation- Ability to maintain confidentiality both of consumer data and provider business practices- 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
Masters
We are here to help you with your questions.