Provider Relations Representative

Brief Description

Join us in transforming healthcare.

About Longevity

At Longevity, we're dedicated to advancing healthcare through innovation, compassion, and excellence. We're looking for passionate individuals to join our team and help us make a difference. The individual holding this position is required to support and demonstrate their commitment to Longevity Health’s purpose: To optimize the quality of life of people in long-term care by focusing on their individualized health needs.

About The Role

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.

The Provider Relations Representative is responsible for maintaining strong relationships with healthcare providers to ensure the delivery of high-quality care to our members. The Provider Relations Representative owns the scope of the provider relationships and is responsible for positive financial outcomes and increasing quality performance within the contracted network. This position is also responsible for the credentialing process by ensuring that healthcare providers meet the necessary qualifications, maintain compliance with organizational and regulatory standards.

Requirements

Key Tasks and Responsibilities:

• Provider Relationship Management: Develop and maintain positive relationships with healthcare providers, including physicians, hospitals, and ancillary services, to ensure their satisfaction and engagement with our managed care plan.
• Onboarding and Training: Facilitate the onboarding process for new providers, ensuring they understand plan policies, procedures, and requirements. Conduct training sessions as needed.
• Oversight of the credentialing process for providers, facilities or health systems in the assigned market. Works directly with CVO to ensure files are processed timely for credentialing and recredentialing and meet compliance requirements both internally and externally. Also, responsible for relationships with delegated entities to ensure quality provider data and timely roster submissions.
• Issue Resolution: Act as the primary point of contact for providers, addressing and resolving any inquiries, concerns, or issues in a timely and effective manner.
• Performance Monitoring: Monitor provider performance metrics and compliance with contractual obligations. Provide feedback and support to help providers meet performance standards.
• Provider Education: Educate providers on plan benefits, changes in policies, new initiatives, and best practices to enhance their understanding and cooperation.
• Data Analysis: Analyze provider data to identify trends, opportunities, and areas for improvement. Use data-driven insights to inform engagement strategies.
  
  

Collaborative Initiatives: Work closely with internal teams, including network management, quality assurance, and member services, to coordinate efforts and support provider needs.

• Documentation and Reporting: Maintain accurate records of provider interactions, issues, and resolutions. Prepare regular reports on provider engagement activities and outcomes.
• Coordinate 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.
• Performs other related duties as assigned.
  
  

Supervisory Responsibilities

• There are no supervisory responsibilities for this position.
  
  

Credentials & Coverage

• There are no licensure requirements for this position.
• Auto insurance coverage as required by your state of residence. New employees will be responsible for providing proof of coverage prior to hiring and on an ongoing basis.
  
  

Education And Training

• High school diploma or equivalent required.
• Bachelor’s degree in a healthcare related field preferred.
  
  

Knowledge And Experience

• Experience: Minimum of 3 years of experience in provider relations, network management, or a related role within a managed care environment.
• Exceptional communication and interpersonal skills.
• Strong problem-solving and conflict resolution abilities.
• Proficiency in data analysis and interpretation.
• Ability to work independently and collaboratively within a team.
• Familiarity with managed care principles and healthcare regulations.
• Proficient in Microsoft Office Suite (Word, Excel, PowerPoint).
  
  

Core Competencies

Decision Making

• Uses sound judgment to make good decisions based on information gathered and analyzed.
• Considers all pertinent facts and alternatives before deciding on the most appropriate action.
  
  

Teamwork

• Interacts with people effectively.
• Able and willing to share and receive information.
• Cooperates within the group and across groups.
  
  

Work Standards

• Sets and maintains high performance standards.
• Pays close attention to detail, accuracy, and completeness.
• Shows concern for all aspects of the job and follows up on work output.
  
  

Motivation

• Displays energy and enthusiasm in approaching the job.
• Maintains high level of productivity and self-direction.
  
  

Reliability

• Takes personal responsibility for job performance.
• Completes work in a timely and consistent manner.
• Sticks to commitments.
  
  

Problem Solving

• Analyses problems by gathering and organizing all relevant information.
• Identifies cause and effect relationships.
• Comes up with appropriate solutions.
  
  

Adaptability

• Adapts to changing work environments, work priorities, and organizational needs.
• Able to effectively deal with change and diverse people.
  
  

Planning and Organizing

• Plans and organizes tasks and work responsibilities to achieve objectives.
• Schedules activities.
• Allocates and uses resources properly.
  
  

Communication

• Expresses ideas effectively.
• Organizes and delivers information appropriately.
• Listens actively.
• Shares complete and accurate information.
  
  

Integrity

• Maintains confidentiality.
• Meets own commitments.
• Adheres to organizational policies and procedures.
  
  

Initiative

• Takes action to influence events and generates ideas for improvement.
• Takes advantage of opportunities.
  
  

Stress Tolerance

• Displays emotional resilience.
• Ability to withstand pressure on an on-going basis.
• Deals with difficult situations while maintaining performance.
• Seeks support from others when necessary.
  
  

Working Conditions

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

• The noise level in the work environment is usually moderate (i.e., office setting with office equipment operating).
  
  

Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations Under the Americans with Disabilities Act (ADA) may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to talk or hear.
  
  

Summary

Company Overview

Longevity Health is a national provider of Institutional Special Needs Plans (I-SNP), created to meet the complex healthcare needs of nursing home residents. Since our founding in 2018, we've expanded our services across several states and formed strategic partnerships to deliver high-quality, patient-centered care. We are actively growing, with plans to continue expanding our services across the nation.

Longevity Health is an Equal Opportunity Employer. We value diversity and encourage applicants of all backgrounds to apply.

COVID-19 Vaccination Policy

Longevity Health follows federal and state regulations regarding COVID-19 vaccinations. Some facilities may still require staff vaccinations to protect the health of residents. Applicants will be required to provide proof of vaccination, or an approved exemption, where applicable.

 

If you are passionate about healthcare and ready to help us drive change in long-term care, apply now to join the Longevity Health team!

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