Location
Denver, CO | United States
Job description
Longevity Health 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, South Carolina, Georgia, Ohio, Texas, 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.
General Purpose: The individual holding this position is required to support and demonstrate their commitment to the Longevity Health 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 Summary: This position of Account Manager is a field-based role which 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 facility and related providers are prepared to offer 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 coordinated 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 of /and be supported by Network, Clinical, and Project Management teams in the organization. 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 or 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 facility, plan, corporate staff, and management.
Areas of responsibility include identifying key providers and supports and coordinating contracting effort by developing relationships with IPAs, hospitals, and key specialty services. Will be supported by Corporate contracting team but must have ability to understand complex and comprehensive contractual arrangements which requires a depth of understanding of managed care, negotiations, and various high- volume services.
Key Tasks and Responsibilities: - Establish facility specific strategy and enrollment goals then lead implementation workplan for assigned facilities and be responsible for the ongoing management of ISNP product 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 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 benefit 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 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 creation and maintaining 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 plan.
- Performs other related duties as assigned.
Licensure: - Valid state driver's license with a good driving record and proof of automobile insurance required.
- Auto liability insurance declaration page with minimum limits of $100,000/$300,000 for bodily injury and $100,000 for property damage with combined single limit of $300,000. You will be responsible for providing this proof of coverage on an annual basis. Newly onboarding employees to this job description should contact HR to discuss any adjustments required to meet this coverage.
Education and Training: Knowledge and 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.
Company Overview: Founded in 2018, Longevity Health started as an Institutional Special Needs Plan (ISNP), a type of Medicare Advantage health plan that addresses significant unmet needs of long-term institutionalized members who reside in nursing homes. Through rapid growth from 2018 to 2022, we expanded our market footprint and currently offer ISNP Medicare Advantage plans in Colorado, Florida, Illinois, Michigan, New Jersey, New York, and North Carolina.
In 2023, we expanded our service offerings to the broader health plan market. In addition to our existing markets where we are both the ISNP and the care management team, we are now partnering with National Carriers on their offered ISNP plans in Ohio, Pennsylvania, upstate New York, Georgia, South Carolina, and Texas, with implementations in progress for several other additional US states. This allows us to utilize our core skills of supporting clinical post-acute needs of this vulnerable senior population Currently 13 markets and expanding rapidly.
Company Disclaimers: Longevity Health 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.
It is the policy of Longevity Health to follow Federal and / or State regulations surrounding COVID vaccinations. While CMS guidelines have been relaxed, there are some LHP facilities which will still require staff be vaccinated in an effort to protect the health of the members / patients we serve. If your assigned location(s) require all staff to be fully vaccinated, you are required to obtain and / or provide documentation related to your COVID vaccination. To confirm whether your assigned location(s) require COVID vaccinations, please refer to the Facility Guide Job Aid located on Longevity Health Plan's intranet site.
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 offers a 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.
Job tags
Salary
