Now Hiring - Healthcare Medicare Advantage Long-Term Care Manager in Cleveland, OH

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, North Carolina, and Pennsylvania, 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.

Company Overview:
Longevity offers an integrated health plan care management platform designed to improve clinical outcomes and reduce unnecessary medical interventions for long-term care beneficiaries living in skilled nursing facilities (SNFs). We offer Institutional Special Needs Plans (I-SNP) that are designated Medicare Advantage plans targeted to beneficiaries with Medicare part A & B who require long-term care in institutional settings. Longevity provides an advanced practice practitioner (NP or PA) supported by LHP RNs and other LHP Clinical team members to work with facility staff, physicians, and caregivers to manage member care in place, and improve their clinical outcomes. I-SNP and the Advanced Practitioner Provider/Clinical Team will improve resident and family satisfaction by providing enhanced benefits specifically tailored to the needs of facility residents.

General Purpose: The individual holding this position is required to support and demonstrate their commitment to the Longevity Health Plan Statement of Purpose, which is: To improve the health and quality of life of nursing home residents by caring for their unique medical, social and emotional needs.

Job Description:

This position of Account Manager is a field-based role which reports to the Market Vice President and whose major focus is to support the member care delivery system and skilled nursing facility partners in providing high quality patient-centered care for I-SNP members. The Account Manager is the main point person of contact for assigned facilities and will coordinate activities of /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.

Key Tasks and Responsibilities:

• Responsible for coordinating all plan functions related to their assigned facilities and leads the joint team effort of delivering high quality and cost-effective program of care in conjunction with facility, plan, corporate staff, and management.

• Serves as the 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.

• Maintains a regular visit schedule for assigned SNFs, visiting each at least monthly and ensuring ongoing communication with all relevant SNF leaders and LHP champion.

• Manages SNF contractual relationships and ensures accurate administration of contract terms. Lead and participate in multidisciplinary teams comprised of contracted provider representatives.

• Identifies and resolves operational issues between plan and facility and coordinates implementation of solutions to ensure positive long-term working relationship.

• Provides ongoing intervention and assistance in the management of contracting, claim payment, facility and provider credentialing, requests for records or data review related to HEDIS or other reporting needs or audits as required, coordinating all communication between Longevity and the facility.

• Completes monthly data reviews and presents educational/best practice topics at cross functional meetings with SNF leadership team.

• Together with Market VP, establishes facility specific strategy and enrollment goals then leads implementation workplan for assigned facilities.

• Identifies key providers and supports contracting effort by developing relationships with IPAs, hospitals, and key specialty services.

• Leads the implementation of I-SNP participating providers in their region and ensures that all assigned participating nursing facility and related providers are prepared to offer Longevity ISNP program.

• Verifies each facility is prepared to successfully launch I-SNP 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.

• With support of clinical team, ensures correct/complete member records within various LHP- utilized systems.

• Regularly documents market-based efforts and current partner interactions, barriers, action plans, etc. to drive increased engagement and high levels of I-SNP penetration.

• Assists in the development of materials and presents as needed during Monthly Operating Review meetings, Business Development meetings and partner-facing Joint Operating Committee meetings.

• Participates in weekly market/clinical team call and monthly clinical-focused meeting.

• Ensures contract compliance with all requirements as set forth by State and Federal agencies.

• Supports 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.

• Supports the compliance program in identifying and responding to compliance deficiencies and corrective action plan.

• Enforces policies and programs that encourage employees and related entities to report suspected fraud and other improprieties without fear of retaliation.

• Supervise and execute special projects as assigned.

• Performs other related duties as assigned.

Licensure:

• Valid state driver’s license with a good driving record and proof of automobile insurance required.

Education and Training:

• Bachelor’s degree.

Knowledge and Experience:

• Relevant Work Experience: 3 plus years of healthcare industry experience with 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.
• Ability to understand complex and comprehensive contractual arrangements which requires a depth of understanding of managed care, negotiations, and various high-volume services.

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 employment with the Company ending.

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.