Director of Provider Network Development - North Carolina
Posted on: February 25, 2021
Director of Provider Network Development - North Carolina
Longevity Health Plan Statement of Purpose: To improve thehealth
and quality of life of nursing home residents by caring for their
uniquemedical, social and emotional needs Longevity Health Plan isa
Medicare Advantage Institutional Special Needs Health Plan (ISNP)
for longterm nursing home residents. Longevity Health Plan covers
all medicallynecessary and preventive services covered under
Medicare Part A(Hospitalization) and Part B (Medical), and Part D
(Prescription Drug). We'refocused on improving our members'
physical, mental, and social well-beingthrough personalized
clinical care and therapies. Longevity Health Plan is growing
rapidlyand is looking to add new talent to our team. Longevity
Health Plan currentlyhas operations in Florida, Illinois, New
Jersey, New York, North Carolina, andOklahoma, with plans to start
up operations in Michigan and additional statesin the very near
future. Due to our rapid growth, we have animmediate need for a
Director of Provider Network Development to support our North
Carolina Market. Position Summary The Director of ProviderNetwork
Development is a field-based role whose major focus is to support
thedelivery system and SNF partners in providing high quality
patient centeredcare for ISNP members. The position will lead the
implementation of ISNPparticipating provider preferred
relationships in their region and will ensurethat all ISNP
Facilities are prepared to offer Longevity ISNP servicesincluding
having fully developed accessible networks, which are trained
andversed in the model of care requirement and prepared to achieve
or exceedgoals. The Director of Provider Network Development will
be the primary pointperson for all ISNP activities at their
assigned facilities includingcontracting, claim payment,
credentialing, records or data review related toHEDIS or other
reporting needs or audits as required, and coordinating
allcommunication between Longevity and the facility. Essential
- Lead the development of all provider contractual relationships
requiredto drive a successful ISNP program in each ISNP
- Main point of provider contracting and support for each ISNP to
ensurethat all required primary, specialty and ancillary providers
are contractedunder cost effective agreements and are fully
oriented, trained and performingto meet plan goals of a high
- Support ongoing cost reduction or contract and relationship
maximizationwith service providers. This includes facilities,
individuals, networks, usinga diverse range of techniques and
contracting ''best practices'', to includecapitation, case rates,
and various fee for services arrangements.
- Execute and manage multiple expansion related priorities for
- Develop, manage and implement Region-wide contracting
strategies. Thisincludes specialty services and the alignment of
contract interests of Plan, andNetwork providers.
- Manage contractual relationships and ensure accurate
administration ofcontract terms. Lead and participate in
multidisciplinary teams comprised ofcontracted provider
- Provide ongoing intervention and assistance in the management
of claims,UM and benefit issues
- Collaborate with Finance and Performance Analysis teams to
identify costsavings initiatives and monitor contract
- Ensure contract compliance with all requirements as set forth
by Stateand Federal agencies.
- Supervise and execute special projects as assigned.
Supportorganization's strict adherence to the Company's Compliance
Plan and Standardsof Conduct with emphasis on compliance with
established procedures andprotocol, internal controls, and
maintaining the highest level of workplacebehavior.
- Create and maintain operational policies and procedures that
supportorganizational improvements and comply with federal and
state requirements.Ensure policies and procedures are reviewed and
updated as needed, at leastannually.
- Enforce policies and programs that encourage employees and
relatedentities to report suspected fraud and other improprieties
without fear ofretaliation.
- Support the compliance program in identifying and responding to
compliancedeficiencies and corrective action plan.
- Performs other related duties as assigned . Education and
- Bachelor'sdegree. Licensure:
- Thereare no licensure requirements for this position. LNHA,
Health Insurance Licenseor Clinical certification/license helpful.
Knowledge and Experience
- 3+ years of healthcare industry experiencewith focus on
provider relations, contracting, and business development.
- Excellent communication and presentation skills to all levels
of staffand management.
- Strong project management and coordination skills. Candidates
must meet the Company'shiring criteria which includes a
pre-employment background and drug screening. Longevity Health Plan
is an EqualOpportunity Employer. All qualified applicants will
receive consideration foremployment without regard to race, color,
religion, gender, national origin,disability status, protected
veteran status or any other characteristicprotected by law.
Longevity Health Plan offers acompetitive compensation and benefits
package which includes medical, dental,vision, short and long-term
disability, life insurance, and 401(k). Apply for this job First
name Last name Email address Location Phone number Resume Attach
resume Attach another file Attach file What are your salary
requirements? per hour What is your earliest start date? What is
the highest level of education you've obtained? What is the highest
level of education you've obtained? We invite you to complete the
optional self-identification questions below used for compliance
with government regulations and record-keeping guidelines. Any
self-identification information provided will not be considered in
the selection process. GENDER Male Female Nonbinary I do not wish
to self-identify my gender ETHNICITY Hispanic/Latino White (Not
Hispanic or Latino) Black/African American (Not Hispanic or Latino)
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(Not Hispanic or Latino) American Indian/Alaska Native (Not
Hispanic or Latino) Two or More Races (Not Hispanic or Latino)
Decline to Specify If you believe you belong to any of the
categories of protected veterans listed below, please indicate by
selecting the appropriate category(ies). The hiring employer is a
Government contractor subject to the Vietnam Era Veterans'
Readjustment Assistance Act of 1974, as amended by the Jobs for
Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA) and requests this
information in order to measure the effectiveness of the outreach
and positive recruitment efforts it undertakes pursuant to VEVRAA.
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served on active duty during a war or in a campaign or expedition
for which a campaign badge has been authorized Recently Separated
Veteran Veteran, but not one of the four protected classes above I
decline to state my veteran status Not a Veteran Because the hiring
employer does business with the government, it must reach out to,
hire, and provide equal opportunity to qualified people with
disabilities. Answering this question is voluntary, but we hope
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against you in any way. Yes, I have a disability (or previously had
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