Innovations Care Manager
Vaya Health
Senior Network Relations Consultant, Value-Based Program Specialist
Elevance Health
full-time
Posted on:
Location Type: Hybrid
Location: Columbus • Ohio • 🇺🇸 United States
Visit company websiteJob Level
Senior
About the role
- Deliver on the LTSS commitment linking provider payment to improved performance
- Support the design and modification of Anthem Value Based Payment (VBP) based on stakeholder feedback and utilization
- Partner with Ohio Department of Medicaid (ODM), LTSS contractors, and stakeholders to deploy VBP methodologies for home and community-based services and long-term care nursing facility services
- Advise on innovative programming and support VBP offerings
- Responsible for provider training, technical assistance, utilization, and performance monitoring related to VBP
- Work collaboratively with stakeholders to define key VBP performance indicators and deliver program performance to providers
- Establish a core set of measures for provider feedback reports standardized across LTSS Contractors
- Coordinate negotiated contracts for new and existing providers as needed
- Function as a high-level technical resource to resolve or facilitate complex provider issues
- Coordinate Joint Operation Committees (JOC) for larger provider groups and drive meetings
- Identify and report on provider utilization patterns impacting quality of service delivery
- Track and conduct provider refresher training as needed
- Research issues that may impact future provider negotiations or jeopardize network retention
- Travel to worksite and other locations, as necessary
Requirements
- Requires a Bachelor's degree or equivalent combination of education and experience
- Minimum of 5 years of customer service experience
- At least 2 years’ experience as a Network Management Representative
- Any combination of education and experience which would provide an equivalent background
- Prior experience as an LTSS or HCBS provider or in a provider office preferred
- Experience training or mentoring preferred
- Value Based contracting/payment concepts experience preferred
- Provider education experience preferred
- Experience presenting to various levels of leadership strongly preferred
- Must be within reasonable commuting distance of one of the listed Ohio offices (unless accommodation granted)
- Travel to worksite and other locations, as necessary
- Work Monday-Friday, 8:00 AM - 5:00 PM Eastern Time
- May be required to become vaccinated against COVID-19 and Influenza for certain patient/member-facing roles
Benefits
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs (unless covered by a collective bargaining agreement)
- medical benefits
- dental benefits
- vision benefits
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
- Range of market-competitive total rewards
ATS Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
Value Based Payment (VBP)provider trainingperformance monitoringprovider educationcustomer servicenetwork managementcontract negotiationutilization analysisstakeholder engagementprogram performance measurement
Soft skills
collaborationcommunicationproblem-solvingleadershipmentoringtrainingfacilitationresearchadaptabilityorganizational skills