Offer summary

Qualifications:

Bachelor’s degree in project management, Business Administration, or related field, or equivalent work experience required., Minimum of three years of relevant account management and operational experience is required., At least two years of Provider Relations experience supporting LTSS and HCBS is required., Knowledge of Medicaid, Medicare, LTSS, and HCBS is essential. .

Key responsibilities:

Own and manage relationships with LTSS and HCBS providers to ensure satisfaction and retention.

Act as a liaison and subject matter expert for providers and internal operations.

Collaborate with internal stakeholders to address provider issues and improve compliance rates.

Prepare and lead meetings with key stakeholders and provide education on LTSS and HCBS services.

Job description

Job Summary:

The LTSS Provider Relations Account Manager is responsible for working in a highly matrixed organization and influencing internal stakeholder relationships. This role will engage with LTSS and HCBS providers to build, manage and maintain relationships, with a strong focus on operational efficiencies, proactive engagement, and reduced burden which all leads to retention of provider relationships and improving member access to care.

Essential Functions:

Own the relationship with LTSS and HCBS providers with a proactive focus on overall provider satisfaction and retention
Develop, maintain, and enhance relationships with key stakeholders including relevant provider associations.
Act as a liaison and SME to providers and operations for the LTSS/HCBS provider network
Work as community partner to assist LTSS/HCBS providers; develop education and establishing a proactive process for these providers.
Work in collaboration with Operations and other internal stakeholders on provider issues including researching providers claim issues and provide a professional and comprehensive response to providers
Work with leadership team to define deliverables and timelines
Improve Electronic Visit Verification compliance rates for provider network
Perform virtual and in-person initial onboarding and ongoing education to provider network.
Prepare and lead internal and external meetings with key stakeholders
Assist with the implementation of strategy on independent provider network
SME for Waiver services for internal and external stakeholders
Collaborate with Care Management, Incident Management and SIU to ensure providers are educated on billing practices.
Provide education to internal and external partners on LTSS and HCBS services, billing, and portal support
Responsible for understanding and educating providers on regulation changes
Collaborate with leadership to ensure initiatives are properly managed
Produce detailed reports, executive summaries, and business decision documents
Provide clarification/verification for all levels regarding status/details
May support other lines of business as needed
Perform any other job duties as requested

Education and Experience:

Bachelor’s degree in project management, Business Administration, or other related field, or equivalent years of relevant work experience required
A minimum of three (3) years of relevant account management, claims, operational and technical or business work experience is required.
A minimum of two (2) years of relevant Provider Relations experience supporting LTSS and HCBS experience is required.
Knowledge of Medicaid, Medicare, LTSS, and HCBS and is required
Experience translating business and contractual requirements is required
Experience with Facets and other operational systems preferred
Accreditation experience preferred

Competencies, Knowledge and Skills:

Proficient in Microsoft Office tools, including Project, Word, and Excel
Advanced troubleshooting, critical thinking, and problem-solving capabilities
Proven ability to effectively interact with all levels of management within the organization
Flexibility during organizational and/or business changes
Demonstrate excellent analysis and collaboration skills
Demonstrate sense of urgency
Ability to effectively and efficiently work within a team
Exceptional written and verbal communication skills
Strong interpersonal and relationship building skills
Ability to work independently and within a team environment
Ability to multi-task and prioritize work to meet project deadlines
Critical listening and thinking skills
Time management skills
Customer service oriented
Decision making/problem solving skills

Licensure and Certification:

Employment in this position is conditional pending successful clearance of a driver’s license record check. If the driver’s license record results are unacceptable, the offer will be withdrawn or, if you have started employment in this position, your employment in this position will be terminated
To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process

Working Conditions:

Mobile Worker: This is a mobile position, meaning that regular travel to different work locations is essential. Will be exposed to weather conditions typical of the location and may be required to stand and/or sit for long periods of time.
Reside in the state of Michigan.
May be required to travel greater than 50% of time to perform work duties. A valid driver’s license, car, and insurance are necessary for work related travel
Required to use general office equipment, such as a telephone, photocopier, fax machine, and personal computer
Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our member and may refer members to other CareSource resources

Compensation Range:

$81,400.00 - $130,200.00

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Salary

Organization Level Competencies