Vaya Health

General

• Conduct telephonic screenings and collect demographic information
• Review and confirm member and recipient eligibility
• Offer provider choices based on consumer requests and service needs
• Schedule appointments within established access time standards
• Link members with contracted providers for clinical assessments
• Identify risk indicators and make immediate referrals to Member and Recipient Services Clinicians
• Handle customer service calls regarding enrollment, services, referrals, provider changes, Social Determinants of Health needs, and general information
• Provide information about Vaya Partners, its provider network, community resources, and North Carolina Medicaid services
• Complete warm transfers and link callers to appropriate parties, providers, vendors, community organizations, and legal guardians
• Document call notes, forms, reports, and other required information in electronic systems
• Report service-system gaps and needs to managers or Provider Network Development staff
• Offer Customer Satisfaction Surveys and adhere to the NCMT Call Grading Rubric
• Assist with specialized ACCESS Call Center projects and perform other assigned duties

ACCESS Member Services Specialist

• Assist network providers with inquiries related to claims, contracts, authorizations, benefits, services, registries, and community resources
• Screen, handle, and route incoming phone calls, aiming for first-call resolution
• Initiate outbound calls based on established work queues, lists, and assignments
• Document all calls and routing activities through defined workflows and processes
• Provide information and respond to providers’ inquiries, concerns, and questions by phone
• Perform initial triage of callers’ needs and determine appropriate call handling
• Educate providers about resources available through Provider Central
• Provide navigation support for forms, training guides, and contracting information
• Authenticate providers, identify needs, and connect callers to the appropriate One Touch workgroup
• Serve as liaison between departments regarding questions, processes, and information resources
• Update materials related to call center operations when assigned
• Serve as a subject matter expert for Provider Support Line call center operations
• Complete progress notes, forms, reports, and other required documentation at the time of the call and by the end of the workday or shift
• Assist with specialized ACCESS Call Center departmental projects and reviews as requested by management
• Perform other duties as assigned

ACCESS Provider Services Specialist

Software Engineer

• Design, architect, and implement custom applications
• Elicit requirements, create application specifications, and design/build custom application solutions
• Interface with functional teams to support application development
• Identify needs or issues, develop strategies, and propose or implement technical and process solutions
• Partner with MIS staff to create, maintain, and support relational databases, access control systems, and web technologies
• Translate gathered requirements into completed applications
• Design and build reusable, reliable code for quality, performance, and responsiveness
• Proactively engage business units to address business needs and infrastructure constraints
• Plan, design, and implement custom applications
• Partner with the Business Intelligence Analyst to analyze workflows, define business requirements, and provide specifications for end-user sign-off
• Coordinate User Acceptance Testing with the Analytics Tester and development team
• Own created applications and manage application operations
• Plan upgrades with stakeholders to minimize user impact
• Develop backup levels and schedules with backup administrators
• Follow change-control procedures and write basic technical documentation
• Monitor supported systems and communicate potential service problems
• Consult with end users and analysts to resolve technical issues and ensure satisfaction
• Develop and execute industry security standards for application development
• Protect user accounts, operating systems, applications, communications, and data
• Maintain technical competency through ongoing professional development

Application Product Developer

• Conduct telephonic screenings and collect demographic information
• Provide callers with choices among available providers and link them to appropriate services
• Link callers to licensed clinicians for urgent or emergent services when needed
• Review and confirm member and recipient eligibility
• Schedule appointments within established access-time standards
• Handle customer-service calls regarding enrollment, service access, referrals, Social Determinants of Health needs, provider changes, and general information
• Provide information about Vaya Partners, its provider network, community resources, and North Carolina Medicaid services
• Identify risk indicators and make immediate referrals to Member and Recipient Services Clinicians
• Resolve caller questions when possible or explain resolution processes and timeframes
• Complete warm transfers and linkages to appropriate parties
• Complete call notes, forms, reports, and other electronic documentation during or immediately after calls
• Monitor service-system trends and report gaps and needs to management or Provider Network Development staff
• Adhere to the NCMT Call Grading Rubric and deliver person-centered, recovery-oriented customer service
• Assist with specialized ACCESS Call Center projects and perform other assigned duties

Manager

• Provide proactive intervention and coordination of care to eligible Vaya Health members and recipients
• Conduct comprehensive Health Risk Assessments covering behavioral, physical, developmental, social, and resource needs
• Develop and update person-centered care plans with members and interdisciplinary care teams
• Link members with appropriate services and supports across medical, behavioral health, I/DD, TBI, pharmacy, LTSS, and social-resource networks
• Administer PHQ-9, GAD, CRAFT, ACES, LOCUS/CALOCUS, and other screenings within scope
• Provide education, self-management strategies, referrals, and therapeutic-support linkages
• Review and document medication information in Vaya’s Care Management platform
• Participate in interdisciplinary care team meetings, multidisciplinary huddles, case staffings, and high-risk team meetings
• Provide crisis intervention, coordination, transitional care management, and diversion support
• Coordinate transitions between levels of care and help prevent institutional placement or rehospitalization
• Monitor service delivery, conduct announced and unannounced visits, and identify provider non-compliance
• Ensure member health and safety, report critical incidents, and escalate concerns
• Verify Medicaid eligibility and coordinate related changes or deductibles
• Create and maintain accurate care-management documentation and Service Authorization Requests
• Collaborate with providers, Vaya departments, community stakeholders, members, families, caregivers, and natural supports
• Participate in required training and perform other duties as assigned

Innovations Care Manager

• Provide proactive intervention and coordination of care to eligible Vaya Health members and recipients
• Conduct comprehensive bio-psycho-social Health Risk Assessments covering social determinants of health, behavioral and physical health, daily living activities, and resource access
• Develop, update, and monitor person-centered care plans, crisis plans, and treatment goals
• Link members with formal and informal services and supports across medical, behavioral health, I/DD, TBI, pharmacy, LTSS, and unmet health-related resource needs
• Administer PHQ-9, GAD, CRAFT, ACES, LOCUS/CALOCUS, and other needs-based screenings
• Review and transcribe medications and maintain multisource medication lists in Vaya’s care management platform
• Participate in and facilitate interdisciplinary care team meetings and complex case staffing
• Provide clinical consultation and technical support to providers; review clinical assessments for accuracy and completeness
• Provide clinical assessments when lack of a clinical home or network provider creates significant member risk
• Provide crisis intervention, coordination, and care management in community settings
• Support transitional care management and coordinate diversion efforts for members at risk of institutional placement
• Collaborate with members, legally responsible persons, caregivers, providers, Vaya staff, DSS, DJJ, CCNC, schools, and community stakeholders
• Monitor service provision, member health and safety, critical incidents, quality of care, and compliance
• Verify continuing Medicaid eligibility and respond to members’ movement outside Vaya’s catchment area
• Create and monitor accurate, timely documentation in the administrative health record
• Maintain compliance with HIPAA, ROI practices, Vaya policies, NCDHHS requirements, and contractual obligations
• Participate in trainings, committees, workgroups, huddles, and other departmental projects
• Travel and conduct work in members’ home communities and other locations

Care Manager – LP

Business Intelligence Developer

• Elicit requirements and create specifications for business intelligence solutions
• Design, architect, and implement complex reporting and BI solutions
• Develop data visualizations, ETL systems, ad hoc queries, reports, data extracts, and master data management solutions
• Interface with functional teams to support BI solution delivery
• Proactively identify needs and issues, develop strategies, and implement technical and process solutions
• Lead large, complex, or specialized BI projects
• Serve as subject matter expert for complex BI solutions
• Mentor and train BI developers and customers
• Interpret business issues and recommend best practices
• Perform BI requirements analysis, design, and implementation
• Collaborate with the Business Intelligence Analyst to define requirements and obtain end-user sign-off
• Coordinate User Acceptance Testing with the Analytics Tester and development team
• Implement final BI solutions and obtain end-user satisfaction
• Follow change-control procedures and write technical documentation
• Monitor supported systems’ health and performance and identify potential service problems
• Participate in professional development activities
• Develop and execute security standards for BI development
• Protect confidential healthcare information and comply with HIPAA, 42 CFR Part 2, and applicable state laws
• Perform other duties as assigned

ACCESS Member Services Specialist

ACCESS Provider Services Specialist

Application Product Developer

ACCESS Member Services Specialist

Innovations Care Manager

Care Manager – LP

Senior Business Intelligence Developer