Vaya Health

Manager

• Provide operational leadership, coordination, and oversight across assigned RHTP initiatives
• Monitor initiative work plans, milestones, deliverables, and implementation schedules
• Ensure alignment with the Region 3 Hub Action Plan
• Serve as the primary operational liaison to the Region 3 Academic Anchor and Regional Anchors
• Coordinate regular implementation meetings with anchor organizations and implementation partners
• Monitor initiative performance metrics and implementation progress across all assigned initiatives

Hub Initiatives Manager

Assessor

• Responsible for completing needs-based assessments/eligibility determinations for Medicaid-beneficiaries
• Conduct assessments to determine whether members meet the conditions and criteria for PCS eligibility
• Schedule assessments and conduct interviews with family members and informal caregivers
• Submit service authorization requests (SARs) on behalf of PCS providers
• Ensure privacy and dignity of individuals receiving assessment is maintained at the highest standards
• Participate in mediation and appeal processes as needed

PCS Assessor, Registered Nurse

General

• Support the implementation and operational oversight of Initiative 1 within NCDHHS&rsquo; defined region 3
• Provide leadership and coordination across healthcare providers, community-based organizations, local health departments, behavioral health entities, social service agencies, and regional implementation partners
• Collaborate with the ROOTS Hub Implementation Manager and region 3 lead anchors to tailor NCRHTP initiatives and activities
• Track Vaya&rsquo;s RHTP plan&rsquo;s compliance and performance against program-related deadlines and milestones
• Facilitate collaboration among providers, community organizations, and regional partners

Co-Lead, ROOTS Hub Initiative

• Lead day-to-day implementation activities related to Initiative 2 priorities, action plans, and regional strategies
• Coordinate prevention, chronic disease management, maternal health, and nutrition-related initiatives
• Support expansion and scaling of evidence-based health improvement programs
• Monitor initiative milestones, deliverables, and operational performance
• Coordinate implementation activities among healthcare, behavioral health, and social service partners
• Identify implementation barriers and recommend operational improvements
• Establish ROOTS Hub that connects medical, behavioral health, and social services to improve availability and access to healthcare in rural communities
• Coordinate within the organization and with lead anchor partners to ensure all Initiative 2 /RHTP responsibilities and requirements are met
• Supporting the ROOTS Hub Initiatives Manager to track Vaya’s RHTP plan’s compliance and performance against program-related deadlines and milestones
• Support development of program-related reports as outlined by Requirements from NC DHHS
• Build and maintain collaborative relationships with healthcare providers, public health agencies, community organizations, and implementation partners
• Support incorporation of community feedback and regional health priorities into implementation activities
• Participate in community engagement activities and ensure community voice is incorporated into implementation planning
• Partner closely with project team, finance department, lead anchors and community stakeholders to ensure the milestones and deliverables for RHTP
• Foster relationships with rural communities and disproportionately burdened populations
• Supporting project plan and providing regular updates to ROOTS Hub Initiatives Manager regarding RHTP successes and challenges
• Attend and/or lead RHTP Initiative 2 related meetings
• Participate in community health assessments to support the development of needed services
• Monitor initiative performance metrics and outcomes
• Assist with preparation of reports, dashboards, presentations, and implementation updates
• Identify opportunities for improvement and support corrective action planning as needed
• Support compliance with NCDHHS requirements and reporting expectations
• Collaborate with other Initiative Leads and ROOTS Hub staff to ensure alignment across initiatives
• Participate in Hub governance and planning activities
• Serve as Initiative 2 subject matter expert as requested

ROOTS Hub Initiative 2 Lead

• The ROOTS Hub Initiative 5 Lead reports to the ROOTS Hub Initiatives Manager.
• Responsible for supporting the implementation and operational oversight of Initiative 5 within NCDHHS’ defined region 3 comprised of several counties.
• Focus on advancing value-based payment readiness, healthcare sustainability, and innovative financing models for rural primary care providers and rural health systems.
• Collaborate with healthcare providers, payers, finance teams, implementation partners, and community stakeholders to support operational transformation, value-based care readiness, fiscal sustainability, and data-informed healthcare delivery improvements within rural communities.
• Serve as a strategic implementation partner to the ROOTS Hub Initiatives Manager and support operational planning, stakeholder engagement, reporting, governance activities, community engagement, and implementation monitoring related to Initiative 5 objectives and deliverables.
• Coordinate with region 3 lead anchors and tribal representatives where applicable and tailor NCRHTP initiatives and activities to meet region 3’s rural health needs and the NCRHTP performance objectives.

Lead, ROOTS Hub Initiative

Quality Specialist

• Serve as Vaya’s RHTP QAPI point of contact and manage & coordinate the development and implementation of internal QAPI activities and implementation of QAPI initiatives.
• Manage and coordinate the development and implementation of internal Quality Assurance Performance Improvement (QAPI) activities and implementation of Hub and/or governing board QAPI initiatives.
• Develop, implement, and evaluate QAPI processes and procedures to monitor and ensure the quality and timeliness of contracted Hub functions.
• Develop and implement stakeholder feedback tools. Gather reports from responsible individuals and other key staff; facilitate QI activities; and compile regular reporting for bi-directional flow of information among the Hub and governance body.
• Conduct regular review and analysis of quality and performance measures, surveys and assessments, incidents, and other data sources to identify quality and performance deficits.
• Design and implement Performance Improvement Projects (PIPs) and other QAPI processes to identify and address quality and performance issues.
• Provide support for the Hub to identify, aggregate, and report barriers to the governance body.
• Develop and strengthen processes to ensure compliance with and timeliness for required reporting, assessments and surveys, and other data submissions, and other required data submissions and reporting tools.
• Provide support as needed for Hub team members to develop and implement data collection tools and procedures to ensure all program requirements are met to support tracking, monitoring, reporting, and to evaluate and ensure the quality of Hub services and functions.
• Assist and support ongoing and ad hoc QAPI responsibilities of the Quality Management department.

Quality Improvement Specialist

Program Specialist

• Provide day-to-day operational support to the ROOTS Hub Director and regional ROOTS Hub Connectors.
• Support documentation of Hub Activities, coordinate meeting logistics, serve as clerk to the Hub Governing Body to prepare agendas and minutes,
• Maintain Feedback-to-Decision log and provide reporting support and coordination of routine communications across various stakeholders.

ROOTS Hub Program Specialist

Business Intelligence Analyst

• Compile, submit, and aggregate program-related reports to the Department by required deadlines
• Support the Hub Director in ensuring subrecipients, implementation partners, and community-based organizations meet reporting expectations
• Gather, develop, review, analyze and monitor performance measures and results required by NC DHHS to ensure compliance and comprehension and to identify potential improvement opportunities.
• Present results, findings, interpretations, and recommendations regarding performance measures to both internal and external stakeholders
• Other duties as assigned.

Performance Reporting Analyst

Care Coordinator

• Responsible for providing proactive intervention and coordination of care to eligible Vaya Health members.
• Ensure individuals receive appropriate assessment and services.
• Work with members and care team to alleviate inappropriate levels of care.
• Coordinate multidisciplinary team care planning and linkage of services.
• Ensure adherence to compliance regulations including HIPAA requirements.

Waiver Care Coordinator

• Provides afterhours, weekend and holiday coverage for the NCServes Coordination Center.
• Conducts biopsychosocial assessments by phone with clients to identify needs in key areas.
• Makes referrals to Network providers to address identified needs based on understanding of eligibility criteria, capacity, location, and client preference.
• Maintains a working knowledge of Network providers’ menu of services, eligibility criteria, intake process and preferences.
• Develops positive working relationships with array of Network providers and attends monthly community meetings.
• Documents all activity in accordance with grant program guidelines and in compliance with internal policies and procedures.
• Elicits feedback from clients and providers to ensure successful engagement.
• Coordinates across other programs and ministries within ABCCM.
• Participates in all appropriate staff, supervision, and training meetings.
• Assumes other duties as assigned by Leadership.

Financial Planning and Analysis

• Track and monitor budget variances.
• Review of expenses and revenues posted to the general ledger.
• Processing and maintaining accounts payable records.
• Preparing necessary financial and compliance reports.
• Manage and track budget for RHTP program.
• Responsible for monthly revenue and expense accruals related to RHTP program.
• Perform reconciliation of revenue and expense accounts.
• Provide any information needed for audits.
• Prepare payments for RHTP program to sub-grantees/community partners.
• Monitor spending trends and identify variances.
• Ensure proper approvals and supporting documentation are maintained.
• Make recommendations for continual process improvements and ensure that procedures are documented.

Financial Analyst

• The Care Manager is responsible for providing proactive intervention and coordination of care to eligible Vaya Health members and recipients to ensure that these individuals receive appropriate assessment and services.
• The Care Manager works with the member and care team to alleviate inappropriate levels of care or care gaps through assessment, multidisciplinary team care planning, linkage and/or coordination of services needed by the member.
• Care Managers support and may provide transition planning assistance to state, and community hospitals and residential facilities and track individuals discharged from facility settings to ensure they follow up with aftercare services.
• This is a mobile position with work done in a variety of locations, including members’ home communities.
• Ensures identification, assessment, and appropriate person-centered care planning for members.
• Links members with appropriate and necessary formal/ informal services and supports across all health domains.
• Meets with members to conduct the HRA and gather information on their overall health, including behavioral health, developmental, medical, and social needs.
• Supports the care team in development of a person-centered care plan to help define what is important to members for their health and prioritize goals that help them live the life they want in the community of their choice.

Care Manager, QP

• Providing proactive intervention and coordination of care to eligible Vaya Health members.
• Works with the member and care team to identify and alleviate inappropriate levels of care.
• Supports and may provide clinical transition planning assistance to state and community hospitals and residential facilities.
• Conducting comprehensive bio-psycho-social assessments addressing health-related resource needs.
• Participation in interdisciplinary care team meetings, and ongoing care management.
• Managing Child/Adult High-Risk Team meetings in collaboration with community stakeholders.