HOTJobs in Tennessee

ValueOptions^®, the nation’s largest independent behavioral health care company, provides services to more than 23 million individuals through a variety of contracts with state and county agencies, as well as with health plans and employers. ValueOptions^® specializes in management for all behavioral health issues, and mental health and chemical dependency diagnoses.

ValueOptions^®, Inc. has contracted with Volunteer State Health Plan (VSHP) to provide behavioral healthcare services to 375,000 TennCare members, Tennessee’s Medicaid population. To launch this exciting new venture, ValueOptions^® is seeking qualified candidates for the following positions.

How many careers offer you the gratification of changing lives for the better? We can offer you this along with a variety of opportunities for professional development, the stability of a career with a nationwide managed care company and so much more!!

Contract Development Director – Flexible Location

The Contract Development Director coordinates the development and management of ValueOptions provider networks, including the initial and (re)contracting and provider network management. Responsibilities include the management and development of provider contract language and provider negotiations that address the contractual requirements set forth by the customer. Negotiations may include complex contract language issues and non-standard financial arrangements. Provides assistance with individual practitioners requiring special fee arrangements or special language consideration. Additionally, administer provider agreement maintenance, provider contract files, etc.

Bachelor’s degree required in Business Management or Health Care Administration or a related field. Five to seven years of progressively responsible and complex management positions in provider relations, provider contracting and/or a combination of managed care, behavioral health care, practice management and claims administration. Specific knowledge of managed care environment, network development and provider community in Tennessee is required. Background in creative fee negotiations, cost sharing arrangements, contract language development and analyzing and reducing cost of care. Excellent written and oral communications skills, flexibility, adaptability, problem solving capability, creativity, initiative, teamwork skills, prioritization skills and public relations skills are required. Interstate travel required.

Compliance Director

This position is responsible for managing all ValueOptions^® Tennessee oversight activities required for compliance with the rules and regulations of the VSHP/VOTN RFP response, the Contract Risk Agreement, the VSHP/VOTN contract and relevant State and Federal statutes and regulations.

This position requires a Bachelors Degree in a healthcare related field. Master’s Degree is preferred. Minimum two years experience in healthcare regulatory and state, federal or local compliance activities. This position requires demonstrated problem solving ability, excellent oral and written communication skills, interpersonal and organizational skills. The ability to manage large projects and multiple tasks simultaneously and be detailed oriented. Experience with TennCare is preferred.

Care Manager

The Care Manager provides assessments, referrals, and triage. Conducts telephone assessments, collecting sufficient data to make appropriate referral and certification decisions for emergency/urgent referrals that require alternate levels of care. Makes appropriate certification decisions. Collaborates with providers to determine alternate levels of care and to facilitate transfers to network facilities and providers whenever possible. Facilitates coordination of care with other care managers to assure continuity of care. Evaluates clinical appropriateness of treatment using professional knowledge within ValueOptions^® clinical and work-site guidelines and renders certification decisions or seeks consultations for non-certification decisions. Manages and coordinate the care of individuals with complex needs who are eligible for disease management or intensive care management; provide intensive assistance and problem-solving to eliminate barriers to care working with providers and consumers.

This position requires licensure in a mental health related field (RN, Ph.D., LCSW/ACSW, LPC, etc.) and 3-5 years experience in psychiatric or substance abuse treatment. Experience in settings that include inpatient, partial, and/or outpatient customer service orientation and excellent written and verbal communication skills required. Must possess the ability to function in an interdisciplinary setting. Strong customer service orientation and excellent written and verbal communication skills are required. Must have knowledge and experience using management information systems, word processing, and spreadsheet applications (Microsoft Word and Excel experience preferred). Knowledge of care resources and levels of care available is essential to success in this position.

To apply for one of our Care Manager positions in Tennessee please follow the link below!!

Grievance and Appeals Coordinator

The Grievance Coordinator requires highly developed organizational and verbal and written communication skills. Coordinate all levels of complaints, grievances and/or appeals to ensure timeliness and compliance with URAC, State and customer standards. Produce necessary documentation for appeals decisions. Assist in design and maintenance of applicable databases for complaints/appeals and other ad hoc QM projects. Work in collaboration with internal ValueOptions staff and providers. Maintain sound customer relations while researching and gathering complaints, grievances and appeals information.

Strong customer service orientation; ability to meet deadlines; high degree of organizational skills needed to meet deadlines. Bachelor's degree required.
Prior experience in managed care or insurance setting. Experience in customer service; ability to maintain positive customer relations necessary.

To apply for our Grievance/Appeals Coordinator position in Tennessee please follow the link below!!

Provider Relations Manager

This position will assist and support the Director, Provider Relations in the oversight of the region’s provider relations operations, including provider education, implementation of strategic network plans, recruiting and monitoring providers, and engaging in effective collaboration with national network operations and contracting teams. Will ensure timely resolution of issues related to provider network, ensures performance standards are met, and represents ValueOptions^® at client meetings. Will participate in the recruitment, hiring, training, and appraisal of regional staff and ensures all provider relations/network functions are carried out in accordance with contractual requirements.

Bachelor’s Degree in human services or a related field is required and at least three years of progressively responsible and complex management positions in provider relations and/or combination of managed care, behavioral health care, practice management, and claims administration. Strong organizational, planning and presentation skills are required. This position does require travel throughout the region.

You may reach all ValueOptions^® career opportunities by clicking the Careers Home link to the left!