Now Hiring - Longevity Health Plan of Illinois, Inc. - Healthcare Account Manager in Orlando, FL

Full description of the position

Job description

Company Overview

Longevity Health Plan Statement of Purpose: To improve the health and quality of life of nursing home residents by caring for their unique medical, social, and emotional needs

Longevity Health Plan is a Medicare Advantage Institutional Special Needs Health Plan (ISNP) for long-term nursing home residents. Longevity Health Plan covers all medically necessary and preventive services covered under Medicare Part A (Hospitalization) and Part B (Medical), and Part D (Prescription Drug). We’re focused on improving our members’ physical, mental, and social well-being through personalized clinical care and therapies.

Longevity Health Plan is growing rapidly and is looking to add new talent to our team. Longevity Health Plan currently has operations in Colorado, Florida, Illinois, Michigan New Jersey, New York, and North Carolina, with plans to start up operations in other states in the very near future. Due to our rapid growth, we have an immediate need for an Account Manager.

Job Summary:

This position of Account Manager is a field-based role that reports to the President of the Medicare Institutional Special Needs (ISNP) Health Plan and whose major focus is to support the delivery system and SNF partners in providing high-quality patient-centered care for ISNP members. The position leads the implementation of ISNP participating providers in their region and will ensure that all assigned participating nursing facilities and related providers are prepared to offer the Longevity ISNP program which includes developing a full and accessible network. Must be trained and versed in the model of care requirement and prepared support facility and our clinical team and partners in achieving or exceeding clinical and quality goals.

The Account Manager is the primary point person for the assigned facility related to Longevity ISNP activities and will lead the resolution of issues by coordinating with internal and external staff to ensure program and operations are successful related to contracting, claim payment, facility, and provider credentialing, requests for records or data review related to HEDIS or other reporting needs or audits as required, and coordinating all communication between Longevity and the facility.

The Account Manager is responsible for coordinating the implementation of ISNP program for assigned facilities including coordinating and presenting at cross-functional meetings with executive through-line staff. The Account Manager is the main point person of contact for their facilities and will coordinate activities or/and be supported by Network, Clinical, and Project Management teams in the organization. The Account Manager is responsible for communicating all enrollment, clinical, and quality targets for their facilities and works collaboratively with other departments to achieve these goals.

The Account Manager supports our plan’s members who have complex care needs by ensuring utmost cooperation between all areas and plan functions that affect the member or their care providers. The Account Manager verifies each facility is prepared to successfully launch ISNP according to schedule and oversees all aspects of a compliant ISNP program at the facility by coordinating all activities across Longevity for the facility, with Longevity vendors and back-office operations, and acts as the liaison with relevant and local provider network.

The Account Manager position is expected to identify and outreach all key providers currently delivering services to facility residents, engage them in participating with the Longevity ISNP program at the facility, and support the contracting process. The Account Manager works with and supports provider relations and contracting staff as appropriate to determine, then achieve contracting goals.

The Account Manager is responsible for coordinating all plan functions related to their assigned facilities and will lead the joint team effort of delivering high quality and cost-effective program of care in conjunction with the facility, plan, corporate staff, and management.

Areas of responsibility include identifying key providers and supports and coordinating contracting efforts by developing relationships with IPAs, hospitals, and key specialty services. Will be supported by a Corporate contracting team but must have the ability to understand complex and comprehensive contractual arrangements which require a depth of understanding of managed care; negotiations, and various high-volume services.

Key Tasks and Responsibilities:

• Establish a facility-specific strategy and enrollment goals then lead implementation work plan for assigned facilities and are responsible for the ongoing management of ISNP products at the assigned facilities including their relationship with network providers.
• Main point of contact between facility and plan. Collaborate with facility management and staff to ensure quality services are provided to members and plan administrative functions are carried out effectively.
• Identify and resolve operational issues between plan and facility and coordinate implementation of solutions to prevent future issues.
• Support ongoing cost reduction or contract and relationship maximization with service providers. This includes facilities, individuals, networks, using a diverse range of techniques and contracting ''best practices'', including capitation, case rates, and various fee for services arrangements.
• Execute and manage multiple facility expansion-related priorities for the Plan.
• Collaborate with Provider, Network, and Contracting team in the development of the region-wide contracting strategy then support the management and implementation as required. This includes specialty services and the alignment of contract interests of Plan and Network providers.
• Manage contractual relationships and ensure accurate administration of contract terms. Lead and participate in multidisciplinary teams comprised of contracted provider representatives.
• Provide ongoing intervention and assistance in the management of claims, UM, and benefits issues.
• Collaborate with Finance and Performance Analysis teams to identify cost savings initiatives and monitor contract performance.
• Ensure contract compliance with all requirements as set forth by State and Federal agencies.
• Supervise and execute special projects as assigned.
• Support the organization's strict adherence to the Company's Compliance Plan and Standards of Conduct with emphasis on compliance with established procedures and protocol, internal controls, and maintaining the highest level of workplace behavior.
• Review and assist in the creation and maintenance of operational policies and procedures that support organizational improvements and comply with federal and state requirements.
• Enforce policies and programs that encourage employees and related entities to report suspected fraud and other improprieties without fear of retaliation.
• Support the compliance program in identifying and responding to compliance deficiencies and corrective action plans.
• Performs other related duties as assigned.

Licensure:

• Valid state driver’s license with a good driving record required.

Education and Training:

• Bachelor’s degree.

Knowledge and Experience:

• Relevant Work Experience: 3 plus years of healthcare industry experience with a focus on provider relations, contracting, and business development.
• Excellent communication and presentation skills to all levels of staff and management.
• Strong project management and coordination skills.

Company policy requires that all employees be vaccinated for COVID-19. The Company will engage in an interactive process with individuals who cannot be vaccinated for medical or sincerely held religious beliefs to determine if a reasonable accommodation can be made. While an exemption/accommodation may be initially granted, if at any time during employment, it is determined that an exemption/accommodation that has been granted is no longer considered a reasonable accommodation, it can result in the exemption/accommodation being revisited.

Candidates must meet the Company’s hiring criteria which include a pre-employment background and drug screening.

Longevity Health Plan is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status, or any other characteristic protected by law.

Longevity Health Plan offers competitive compensation and benefits package which includes medical, dental, vision, short and long-term disability, life insurance, and 401(k).

Submission of false information during the application process may result in immediate termination of employment without notice.and 401(k).

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Employee discount
• Flexible schedule
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Mileage reimbursement
• Paid time off
• Travel reimbursement
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Supplemental pay types:

• Bonus pay

Travel requirement:

• Up to 75% travel

Application Question(s):

• Are you fully vaccinated for COVID-19?
• What is your desired salary?

Education:

• Bachelor's (Required)

Experience:

• Project management: 1 year (Required)
• Business management: 1 year (Required)
• provider relations and contracting: 1 year (Required)
• Healthcare industry with Medicare: 3 years (Required)

Work Location: On the road