Supervisor-Provider Network Evaluation-Clinical Quality Review (Full-time Remote, Wake, Cumberland or Johnston Counties, NC) (Personal Services)

The Supervisor-Provider Network Evaluation-Quality Clinical Review (CQR) will be responsible for managing all routine provider monitoring activities performed by Provider Network Evaluators. This position will provide leadership, clinical oversight, and mentoring to Evaluators to ensure monitoring activities adhere to DHB, DMA, and MCO contractual rules and guidelines so that sufficient, safe, and effective services are provided to consumers who have been identified as having Mental Health, Intellectual/Developmental Disabilities or Substance Use needs.

The Supervisor-Provider Network Evaluation-CQR will have experience with Medicaid services, Clinical Coverage Policies, rules and regulations. The Supervisor-Provider Network Evaluation-CQR will ensure staff have the necessary assistance, support, training, and education to perform effective monitoring and review activities so providers can succeed and continue to serve consumers. The Supervisor-Provider Network Evaluation-CQR will assist the Director of Network Evaluation to develop policies, procedures, and quality indicators for Alliance Provider Network while ensuring all required monitoring data is maintained.

This position is full-time remote. The selected candidate must reside in North Carolina and within a 60-mile radius of Wake, Johnston, and Cumberland counties. Some travel to onsite meetings, conferences, provider locations/offices, and legal proceedings may be required.  

Responsibilities & Duties

Manage Department Policies, Procedures, and Standards

• Ensures all mental health, substance use and I-DD programs, services, and systems are provided in accordance with Local, State and Federal Performance Standards, and congruent with organizational and procedures manuals
• Develop monitoring tools, policies and procedures pertaining to behavioral health, substance use and I-DD services
• Oversee development and implementation of MCO standards for service monitoring, quality improvement and evaluating delivery of services to consumers and families
• Organize and maintain a plan to ensure provider monitoring is scheduled as well as completed in compliance with DHB, DMA, and MCO contractual requirements
• Provide clinical oversight of monitoring activities ensuring providers meet clinical requirements of service definitions, employ evidence-based practices, and that findings are accurately and appropriately documented

Network Operations

• Report to Director of Network Evaluation, and Compliance Committee as appropriate, the summary of monitoring and investigations
• Develop and maintain data to track monitoring activities and quality indicators. Report outcomes and findings to Director of Network Evaluation

Manage and Develop Staff

• Provide administrative and clinical oversight to Provider Network Evaluator I and II staff
• Ensure all personnel policies and procedures are followed during the hiring process and staff tenure
• Oversee staff onboarding process through orientation and training to ensure they become familiar as well as knowledgeable about local, state, Federal and MCO contractual requirements; policies, procedures, and protocols for conducting monitoring and reporting results; and all other applicable agency policies and procedures
• Provide clinical and regulatory oversight to ensure providers adhere to requirements of service definitions, regulations, codes and clinical issues are appropriately evaluated during monitoring
• The Provider Network Evaluator Supervisor is a licensed clinician supervising a team of licensed clinicians and non-licensed staff in both clinical and regulatory aspects of monitoring

Travel

• Travel between Alliance offices, attending meetings on behalf of Alliance, participating in Alliance sponsored events, etc. may be required
• Travel to meet with members, providers, stakeholders, attend court hearings etc. is required

Minimum Requirements

Education & Experience

Master's degree in mental health, public health, social work, psychology and four (4) years post-degree experience in a community, business, or governmental program in behavioral health related field, including a minimum of one year of supervisory, consultative or administrative experience.  Must maintain a valid driver's license and a good driving record. An active North Carolina licensure as a LCSW, LPC, LCAS, LPA or LMFT is required.

NCIT (CLEAR) training required or must be obtained within six (6) months of hire.

Preferred:

Experience in any of the following areas would be valuable for this employee: Compliance rules, regulations, and administrative code; monitoring, quality assurance/quality improvement activities.

Knowledge, Skills, & Abilities

• Strong foundational knowledge of Excel, public speaking, mediation, presentation development, group facilitation, advocacy, and project management
• Knowledge with rules, regulations, and administrative code
• Exceptional interpersonal skills, highly effective communication ability, and the propensity to make prompt independent decisions based upon relevant facts
• Problem solving and conflict resolution skills are essential
• Detail oriented, able to independently organize multiple tasks and priorities, and effectively manage under pressure of deadlines
• Ability to supervise, train and instruct staff
• Ability to plan, assign, and supervise the work of subordinate employees
• Clinical expertise required to supervise the licensed clinicians monitoring providers and ensure that providers meet clinical requirements of service definitions and contractual expectations
• Effective communication skills are essential
• Ability to learn and understand legal, waiver and program practices/requirements and apply this knowledge in problem-solving and responding to questions/inquiries. Employee must provide a positive image of the BH-MCO at all times

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

Salary Range

$77,868 - $99,282/Annually

Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity. 

An excellent fringe benefit package accompanies the salary, which includes:  

• Medical, Dental, Vision, Life, Long Term Disability
• Generous retirement savings plan
• Flexible work schedules including hybrid/remote options
• Paid time off including vacation, sick leave, holiday, management leave
• Dress flexibility

Education

Required

• Masters or better in Human Services

Licenses & Certifications

Required

• Lic Clin Addiction Spec
• Lic Clinical MH Counselor
• Lic Clinical Social Wkr
• Lic Marr & Family Ther
• Lic Prof Counsel (LPC)

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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