Key Tasks and Responsibilities:

• Responsible for coordinating all plan functions related to their assigned facilities and leads the joint team effort of delivering high quality and cost-effective program of care in conjunction with facility, plan, corporate staff, and management.
• Serves as the main point of contact between facility and plan; collaborates with facility management and staff to ensure quality services are provided to members and plan administrative functions are carried out effectively.
• Maintains a regular visit schedule for assigned SNFs, visiting each at least monthly and ensuring ongoing communication with all relevant SNF leaders and LHP champion.
• Manages SNF contractual relationships and ensures accurate administration of contract terms.
• Leads and participates in multidisciplinary teams comprised of contracted provider representatives.
• Identifies and resolves operational issues between plan and facility and coordinates implementation of solutions to ensure positive long-term working relationship.
• Provides ongoing intervention and assistance in the management of contracting, claim payment, facility and provider credentialing, requests for records or data review related to HEDIS or other reporting needs or audits as required, coordinating all communication between Longevity and the facility.
• Completes monthly data reviews and presents educational/best practice topics at cross-functional meetings with SNF leadership team.
• Together with Market VP, establishes facility specific strategy and enrollment goals then enacts strategy within assigned facilities.
• Identifies key providers and supports contracting efforts by developing relationships with IPAs, hospitals, and key specialty services.
• Leads the implementation of I-SNP participating providers in their region and ensures that all assigned participating nursing facility and related providers are prepared to offer Longevity ISNP program.
• Verifies each facility is prepared to successfully launch I-SNP 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.
• With support of clinical team, ensures correct/complete member records within various LHP-utilized systems.
• Regularly documents market-based efforts and current partner interactions, barriers, action plans, etc. to drive increased engagement and high levels of I-SNP penetration.
• Assisting the development of materials and presents as needed during Monthly Operating Review meetings, Business Development meetings and partner-facing Joint Operating Committee meetings.
• Participates in weekly market/clinical team call and monthly clinical-focused meeting.
• Ensures contract compliance with all requirements as set forth by State and Federal agencies.
• Defines and develops sales opportunities within assigned territory.
• Educates Skilled Nursing Facility personnel on Longevity Health Plan benefits, as well as compliant lead generation.
• Generates leads through education, relationships and ongoing SNF census reviews.
• Conducts benefit presentations with potential members, family members or Responsible Parties.
• Completes daily lead management and required documentation.
• Ensures timely and accurate application processing.
• Participates in Sales-focused meetings and coordinates with Regional Sales Manager for ongoing job training and support.
• Ensures, enforces, and supports 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.
• Supports the compliance program in identifying and responding to compliance deficiencies and corrective action plan.
• Complies with Sales Agent ethics standards in accordance with applicable statutes and regulations.
• Enforces policies and programs that encourage employees and related entities to report suspected fraud and other improprieties without fear of retaliation.
• Supervises and executes special projects as assigned.
• Performs other related duties as assigned.
  
  

Supervisory Responsibilities:

• There are no immediate supervisory responsibilities for this position.

Credentials & Coverage:

• License to sell Medicare Health Insurance Producer License required at the time of hire.
• 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:

• Bachelor’s degree required.

Knowledge and Experience:

• Relevant Work Experience: 3 plus years of healthcare industry experience with focus on provider relations, contracting, and business development.
• Minimum 2 years of sales experience required.
• Excellent communication and presentation skills to all levels of staff and management.
• Strong written and verbal communication skills.
• Strong project management and coordination skills.
• Ability to understand complex and comprehensive contractual arrangements which requires a depth of understanding of managed care, negotiations, and various high-volume services.
• Travel in assigned territory and possible travel to other markets as needed and/or interested.
• Proficiency in computer skills and Microsoft Office Suite products.
• Comfortable working in a Skilled Nursing Home environment.