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Director of Provider Network Development - North Carolina

Company: Aircall
Location: Greensboro
Posted on: February 25, 2021

Job Description:

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 Functions

  • Lead the development of all provider contractual relationships requiredto drive a successful ISNP program in each ISNP facility.
  • 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 performing network.
  • 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 Plan.
  • 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 representatives.
  • 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 performance.
  • 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 Training:
    • 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) Native Hawaiian/Other Pac Island (Not Hispanic or Latino) Asian (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. Disabled Veteran Armed Forces Service Medal Veteran Veteran who 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 that you will choose to complete it. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way. Yes, I have a disability (or previously had a disability) No, I don't have a disability I do not wish to answer this question

Keywords: Aircall, Tuscaloosa , Director of Provider Network Development - North Carolina, Executive , Greensboro, Alabama

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