Provider Network Manager - LTSS & Contracting
Provider Network Manager - LTSS & Contracting
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Job Description
Anticipated End Date:
Position Title:
Provider Network Manager - LTSS & ContractingJob Description:
Be Part of an Extraordinary Team
The MyCare Ohio Plan program is to deliver highquality trauma informed culturally competent personcentered coordination for all members that addresses physical health behavioral health long term services and supports and psychosocial needs.
Provider Network Manager - LTSS & Contracting
Location: This position is based in Ohio; the associate will report to one of our 4 office locations in the state of Ohio.
On-Site Requirement: This role requires associates to be in-office 1-2 days per week fostering collaboration and connectivity while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work promoting a dynamic and adaptable workplace. Alternate locations may be considered.
The Provider Network Manager - LTSS & Contracting is responsible for developing the LTSS provider network through contract negotiations (language and rates) relationship development and servicing.
The primary focus of this role is contracting negotiating and executing contracts for new and existing providers. Typically works with less-complex to complex providers. Providers will be long term services and supports focused and may include but are not limited to Home and Community Based Service waiver providers skilled nursing providers case management agencies smaller institutional providers or ancillary providers.
How You Will Make an Impact
Primary duties may include but are not limited to:
In conjunction with our network development team will assist with building the LTSS provider network to ensure a sufficient and qualified LTSS provider network.
Monitors the LTSS provider network for gaps and/or opportunities to support conversations with providers to expand their business via service offerings and/or geographically to serve LTSS members.
Executes a LTSS network development plan which includes best practice processes related to provider enrollment contracting credentialing (as needed) and new provider recruitment.
Fluent in communicating contract terms payment structures and reimbursement rates to provider and maintains positive provider relationships.
Contracts may involve non-standard arrangements that require a moderate level of negotiation skills.
Works with increased independence and requires increased use of judgment and discretion.
Maintains and tracks contracts and documentation within a tracking system.
May work on cross-functional projects requiring collaboration with other key areas.
Serves as a communication link between professional providers wishing to join the LTSS network.
May conducts more complex negotiations and drafts related documents related to single case agreements.
Functions as a high-level technical resource to resolve or facilitate complex provider issues.
Participates in Joint Operation Committees (JOC) of larger provider groups and participates in the discussion of issues and changes.
Tracks and conducts provider training as assigned.
Assists in preparing State responses State reporting annual audits financial projections and conducting outcome analysis as required.
Researches issues that may impact future provider negotiations or jeopardize network retention.
Serves as a knowledge expert regarding LTSS provider contracting and has a broad understanding of LTSS credentialing requirements and qualifications.
Travels to worksite and other locations as necessary.
Minimum Requirements:
Requires a BA/BS degree and a minimum of 3 years experience in contracting provider relations provider servicing; or any combination of education and experience which would provide an equivalent background.
Preferred Skills Capabilities and Experiences:
Data analysis experience is preferred.
Previous LTSS experience is very strongly preferred.
Understanding of value based concepts and fee schedules is strongly preferred.
Experience with LTSS provider contracting and credentialing is a huge plus and strongly preferred.
Exceptional proficiency in written and verbal communication skills preferred.
Previous Medicaid or LTSS claims experience is preferred.
Strong attention to detail is very important and highly preferred.
Job Level:
Non-Management ExemptWorkshift:
1st Shift (United States of America)Job Family:
PND > Network ContractingPlease be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes including those submitted to hiring managers are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy power our business outcomes and drive our shared success - for our consumers our associates our communities and our business.
We offer a range of market-competitive total rewards that include merit increases paid holidays Paid Time Off and incentive bonus programs (unless covered by a collective bargaining agreement) medical dental vision short and long term disability benefits 401(k) match stock purchase plan life insurance wellness programs and financial education resources to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager associates are required to work at an Elevance Health location at least once per week and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age citizenship status color creed disability ethnicity genetic information gender (including gender identity and gender expression) marital status national origin race religion sex sexual orientation veteran status or any other status or condition protected by applicable federal state or local laws. Applicants who require accommodation to participate in the job application process may contact for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal state and local laws including but not limited to the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Required Experience:
Manager
Employment Type
Full-Time
