What are the responsibilities and job description for the Provider Monitoring Specialist position at Eastpointe?
Position: Provider Monitoring Specialist
Category: Non -Exempt
Location: Remote Position
Salary Range: $51,175 - $56,487
Closing Date: Wednesday, November 8, 2023
Position Number: 17-40-2017
Position Description: The Provider Monitoring Specialist is responsible for monitoring of the Network of Providers’ service delivery and performance system and the providers’ compliance with standards and best practices, as set forth by the MCO, NC Department of Health and Human Services, and applicable accrediting agencies. This position is responsible for the assessment of services delivered to consumers to ensure that they are delivered in a manner consistent with funding requirements, best practices, provider contracts and federal/state rules and regulations. This position monitors provider agencies and independent practitioners within the MCO provider network receiving reimbursement for service provision under waiver, Medicaid/State/Local funding and contract requirements. This position also provides technical assistance to providers regarding compliance with standards, quality of care issues, performance expectations, documentation requirements and the development and monitoring of corrective action plans. This position will assist with compiling data that will be used by the MCO.
Responsibilities and Duties:
The Provider Monitoring Specialist responsibilities are (though not limited to):
- Provider monitoring and Support –Conduct monitoring’s of service providers within the MCO provider network. Conduct routine monitoring’s for compliance verification of service providers to ensure that all providers meet the minimum requirements as set forth by the MCO, the Department of Health and Human Services and other applicable regulatory entities. Conduct targeted/focused monitoring of providers as indicated from routine monitoring or as a result of investigation of complaints. Provide technical assistance to service providers regarding compliance, quality of care, performance expectations, and service delivery and documentation requirements. Complete provider reports regarding monitoring activities.
- Monitoring Follow Up and Resolution – Provide technical assistance to service providers in developing and implementing corrective action plans and appropriate follow up. Follow up on all recommended corrective action plans to assure that all services are within standards guidelines, identified problems are solved and effective and efficient work is reinforced. Complete provider reports regarding follow up and corrective action plan activities.
Education/Experience: Master’s degree in psychology, social work, education, health, business administration or related human service field and two years of experience in professional level treatment programming for the applicable client populations; or a bachelor’s degree in one of the fields listed above and three years of experience as indicated above. Must reside in North Carolina.
Excellent Benefit Package to Include:
- Employer paid Health, Dental, Life and Long Term Disability Insurance
- NC Local Government Retirement
- NC 401K with up to 5% employer match
- 13 paid holidays per year
- Monthly sick and vacation leave earnings
Salary : $51,175 - $56,487