1915(i) System Director (Remote NC)

LOCATION: Remote - can live anywhere in North Carolina or within 40 miles of the North Carolina border. Incumbent is required to maintain this residency for this role.

GENERAL STATEMENT OF JOB

The 1915(i) System Director (System Director) reports to the Vice President (VP) of Care Management (CM) and is a strategic leadership position that will support and guide Vaya-wide program functions. The System Director provides organization-wide leadership and coordination for key operational and strategic initiatives and is responsible for design and implementation of 1915(i) program policy and procedure. The System Director works closely with and integrates support and oversight of related programs and initiatives, including but not limited to Innovations Waiver, TBI Waiver, and Long-Term Services and Supports. This position oversees program workflows, state reporting, related projects, workgroups, and provider oversight functions to ensure alignment with organizational goals and regulatory requirements. Serving as a liaison with state partners, the System Director identifies system challenges, recommends process improvements, and facilitates collaboration across departments to drive efficiency, compliance, and quality outcomes. While the role has no direct reports, it influences and organizes cross-functional work to support Vaya's strategic direction and performance in 1915(i) program implementation.

ESSENTIAL JOB FUNCTIONS

Strategic Leadership:

• Provides organization-wide direction and alignment for the 1915(i) program and initiatives that advance Vaya's organizational goals and strategic pillars
• Leads planning, implementation, and evaluation of 1915(i) program workflows and processes ensuring milestones and deliverables are met
• Ensures coordination across clinical, operational, and administrative areas responsible for program implementation
• Acts as business owner for related projects and leads cross-functional strategic meetings
• Influences and coordinates the work of cross departmental leaders and staff to achieve objectives, promote accountability to shared workflows, and enhance collaboration without direct supervisor authority
• Provides clinical consultation and "dotted line" support of the day-to-day operations of the CM 1915(i) Care Coordination (CC) Teams and Tailored Care Managers (TCM) providing 1915(i) coordination
• Serves as the designated Vaya liaison to NCDHHS for 1915(i) program operations and ensures that key parties internal and external to Vaya have needed information about requirements, updates, and changes
• Is responsible for disseminating information and supporting 1915(i) education within Vaya's provider network, including Provider TCM entities and 1915(i) service providers, to promote understanding and high-quality operations throughout Vaya's network
• Ensures ongoing compliance with internal and external regulatory standards during Tailored Plan functions

Quality and Data Management:

• This position is responsible for ensuring 1915(i) care management and care coordination is implemented and aligned with requirements
• Works closely with operational and administrative teams to develop data tools to monitor implementation
• Work with CM Directors to use data to develop best practice CM and CC strategies, use data to develop team performance goals, and support engagement strategies and workflows
• Identifies risks and organizes efforts to address them
• Prepares summaries, presentations, and updates for leadership teams translating complex program information into clear, understandable content
• Supports operational teams in preparation for internal and external audits
• Works with leadership team to develop performance improvement plans or other quality monitoring tools to support performance expectations

Regulatory and State Reporting:

• Oversees compliance with state reporting requirements
• Ensures accurate, timely submission of data and reports
• Serves as primary liaison to NCDHHS on 1915(i) matters

Collaboration and Program Operations:

• Organize and facilitate collaboration among departments, workgroups, and providers to streamline workflows, improve communication, and reduce gaps
• Works in collaboration with Vaya's Utilization Management BH/IDD/TBI Clinical Director to ensure consistency and coordinated operations across teams and service lines
• Support provider relations and oversight of 1915(i) care coordination and services, including Provider TCM entities and 1915(i) service providers
• Develops and maintains collaborative relationships with other internal and external leaders, payor partners, and teams
• Attends Provider Advisory Council meetings and serves as liaison between Vaya and stakeholders within this area of expertise
• At the request of operations and administrative teams, this position may participate in or provide guidance or expertise, when needed, in interdisciplinary care teams or department meetings
• Develops and provides 1915(i) training and educational materials for internal and external stakeholders to ensure compliance with policies and accreditation standards
• Designs and implements policy and procedure for Care Managers and Care Coordinators to support access to 1915(i) program and services

KNOWLEDGE, SKILLS, & ABILITIES

• This position requires a high degree of autonomy, professional relationships, organizational, and project management skills.
• Employee will participate in and maintain Care Management and Vaya trainings and proficiencies as required.
• A high level of diplomacy and discretion is required to effectively negotiate and resolve issues with minimal assistance.
• This will require exceptional interpersonal skills, highly effective communication ability, and the propensity to make prompt independent decisions based upon relevant facts.
• This position must possess strong written and verbal communication skills.
• Problem solving, negotiation, arbitration, and conflict resolution skills are essential to balance the needs of both internal and external customers. Must be highly skilled at shifting between macro- and micro-level planning, maintaining both the big picture and seeing that the details are covered.
• System Director must exhibit a thorough understanding of the Diagnostic and Statistical Manual of Mental Disorders (current version) and have considerable knowledge of the MH/SU/DD service array provided through the network of Vaya providers.
• Additional knowledge in Vaya Medicaid waivers and accreditation is essential.
• The employee must be detail-oriented, able to organize multiple tasks and priorities, and to effectively manage projects from start to finish.
• Work activities quickly change according to mandated changes and changing priorities within Vaya and NCDHHS, so adaptability and discernment are essential.
• The employee must be able to change the focus of his/her activities to meet changing priorities.
• System Director should be proficient in the aforementioned essential job functions. Job functions with higher consequences of error may be identified, and proficiency demonstrated and measured through job simulation exercises administered by the supervisor where a minimum threshold is required of the position.
• The System Director must have thorough knowledge of standard office practices, procedures, equipment, and techniques and have intermediate to advanced proficiency in Microsoft Office products (Word, Excel, Power Point, Outlook, Teams, etc.).
• Thorough knowledge of the following: DSM (current version) and ICD (current version); Care Management and population health principles, practices, and application; clinical behavioral health and integrated care principles, techniques, and practices, and their application to member care.
• Demonstrated expert decision-making skills rooted in empirical science (ex. Eight Essential Nurse Leader Competencies for 2020, Huston, 2008).
• Knowledge of Medicaid criteria, including but not limited to eligibility for Vaya Health Plans, service definitions, entitlements and restrictions for state plan Medicaid services, 1915(c) Waiver, 1115 Waiver criteria, and general knowledge of Long-Term Services and Supports; Non-Medicaid Vaya Health Plan, levels of care, and service definitions; state/local governmental, regional/local healthcare systems, private organizations, and resource brokers in the community.
• Knowledge of Vaya Health contracts with NC Division of Health Benefits (DHB), NC Division Mental Health/Developmental Disabilities/Substance Abuse Services (DMH/DD/SAS) and other contracts for which Vaya Health is responsible; Vaya Health organizational purpose/role per federal and state statute, strategic plan, leadership and departmental roles, relationships, and scope; federal and state confidentiality requirements; member and staff health & safety requirements; corporate compliance requirements; Vaya Health policies and procedures; and project management principles.
• Ability to oversee and influence multidisciplinary, cross-functional, clinical and professional teams across the 1915(i) service area.
• Ability to identify departmental quality and workflow improvement, develop a logical cohesive plan and implementation strategy.
• Maintain well-organized, written, electronic notes regarding program management, needs, and successes.
• Comport her or himself in a professional capacity in attire, speech and behavior internally and externally when representing Vaya Health.

Additional requirements include but are not limited to:

• Clear, concise, and appropriate verbal, written, and electronic communication;
• Ability to present publicly in large group settings;
• Ability to adapt to rapid changes;
• Effectively develop and implement current/new initiatives;
• Computer literacy and familiarity with standard office computer software as well as Vaya Health's systems, Excel, Visio, Project Management Software, or other required portals or data bases.

EDUCATION & EXPERIENCE REQUIREMENTS

Master's degree in a field related to health, psychology, sociology, social work, nursing, public health, healthcare administration, business administration, or another relevant human services area is required. Must also have:

• 5 years of progressively responsible experience in healthcare administration, program strategy, or cross-system program implementation
• 5 years of clinical physical health, MH/SU/IDD experience
• 3 years of experience in an LME/MCO

Licensure/Certification Preferred:

Clinical licensure not required but preferred. Master's-level fully Licensed Clinical Social Worker (LCSW), fully Licensed Clinical Mental Health Counselor (LCMHC), fully Licensed Psychological Associate (LPA), fully Licensed Marriage and Family Therapist (LMFT) or licensure as a Registered Nurse (RN)

PHYSICAL REQUIREMENTS

• Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading.
• Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists, and fingers.
• Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time.
• Mental concentration is required in all aspects of work.

RESIDENCY REQUIREMENT: The person in this position is required to reside in North Carolina or within 40 miles of the North Carolina border.

SALARY: Depending on qualifications & experience of candidate. This position is exempt and is not eligible for overtime compensation.

DEADLINE FOR APPLICATION: Open Until Filled

APPLY: Vaya Health accepts online applications in our Career Center, please visit https://www.vayahealth.com/about/careers/.

Vaya Health is an equal opportunity employer.