DIRECTOR OF PROVIDER RELATIONS AND SALES in Wilmington, North Carolina at Liberty Healthcare Management

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We are currently seeking an experienced:

DIRECTOR OF PROVIDER RELATIONS AND SALES

Job Summary:

• Oversee and manage plan operations within contracted SNFs and provide education to help SNFs understand and meet plan goals and CMS compliance requirements. Specific areas of oversight include, but are not limited to the following:
  • Model of Care Implementation
    • Inpatient Admissions per Thousand
    • Emergency Department visits per Thousand
  • Enrollment/Disenrollment
  • Provider Network Management
    • Claims
    • Grievance and Appeals
    • Utilization Management
• Works with the Plan Executive Director to monitor plan metrics and identify any metrics trending unfavorably and implementing a strategy to resolve any underlying issues.
• Visits contracted SNFs to strengthen relationship with the plan, identify any plan-related issues the SNF may be experiencing, touch base with plan NP. Facility Champion and Administrator.
• Trains/Educates SNFs on role of the Nurse Practitioner model of care and the importance of timely communication of decline in member status.
• Ensures SNF and Facility Champion understand the disenrollment process for plan members discharging out of the SNF.
• Educates SNF leadership on the value-based payment model contract with Liberty Advantage.
• Distributes and reviews metrics with SNF Administrator and DON on a monthly basis.
• Distributes monthly rosters to SNF Administrators and Facility Champions.
• Responsible for implementation of plan operations in newly contracted SNFs.
• Manages Sales Team to ensure plan enrollment is on track to meet plan goals.
• As necessary, researches provider claims issues or other issues, and get them to the most appropriate person to resolve
• As necessary, researches member issues as it relates to the plan and ensures it gets to the most appropriate person for resolution.
• As needed, travels to provider offices to negotiate contracts for network adequacy.
• Ensures that policies and procedures are developed, updated, and adhered to for the operations area to maximize performance through monitoring and training

Job Requirements:

• Bachelor's degree preferred; a concentration in Health Care Administration, Business, or Management preferred
• In absence of Bachelor’s degree, 15+ years of related managed care experience
• 5+ years of Medicare Advantage experience in an operational capacity
• 5+ years of experience in leading teams of operational staff
• Must have a valid driver’s license

• Exceptional interpersonal skills
• Willingness and ability to travel to complete on-site visits with providers and vendors

• Exceptional organizational skills
• Strong background in process development and implementation
• Ability to advise IT resources related to enterprise platform initiatives
• Exceptional leadership skills and operational management expertise
• Strong analytical and problem solving skills
• Working knowledge of relevant federal and state regulations and requirements
• Ability to stay apprised of ongoing changes that impact health plan operations

Visit www.libertycareers.com for more information.
Background checks/drug-free workplace.
EOE.