Overview This position will be responsible for the oversight of
Long Term Services and Supports (LTSS). Requires attention to detail and strong communication skills to adequately represent the organization at conferences and speak in front of an audience. Will be responsible for the
long term care team with direct supervision of staff. Must possess a strong background in
claims processing, managed care guidelines, New Mexico Human Services Department regulations LTSS. Act as a key resource for Provider Services and provide education with an emphasis on LTSS. This position re-quires an ability to work effectively within a complex organization across multiple departments to drive results. May require some travel and the ability to work with other Managed Care Organizations (MCO) to create a collaborative approach to LTSS
We're determined to take care of those working in healthcare. Presbyterian is dedicated to improving people's lives - the lives of our patients and the lives of our coworkers. We're a locally owned and operated, which encourages supportive leadership that empowers employees. And we provide the opportunity to grow from entry-level to the most senior positions.
Why Join Us - Full Time - Exempt: Yes
- Job is based at Rev Hugh Cooper Admin Center
- Work hours: Days
- Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.
Ideal Candidate: - Bachelors degree
- Previous supervisory skills
- Experience with LTSS
- Experience with use of membership data, claims and/or encounter data
- Experience with Provider Relations/Services across multiple specialties
Qualifications - Bachelors degree required. 6 years of additional experience can be substituted in lieu of degree. Previous supervisory skills required
- Experience with LTSS
- Experience with use of membership data, claims and/or encounter data
- Experience with Provider Relations/Services across multiple specialties
- Leadership skills to work across teams, drive results, and lead initiatives
- Business acumen and the ability to build credibility with all levels of the organization
- Knowledge of Healthcare benefits, terminology and concepts- especially as it relates to LTSS
Responsibilities - Work as part of the Provider Services staff and leadership to ensure provider participation in LTSS.
- Provide education and guidance to staff to conduct on-site visits with Providers and/or facilities to educate and inform providers and staff on LTSS
- Monitor and use information from the EVV system to verify that services provided are specified in the individual plan of care and in accordance with the established schedule, including the amount, frequency, duration and scope of each service and that services are provided by the authorized provider.
- Identify and immediately address service gaps, including late and missed visits.
- Monitor services anytime the member is receiving services including after regular business hours.
- Develop and maintain positive relationships with providers, vendors, other MCOs and the Mexico Human Services Department (HSD)
- Identify areas of opportunity for partnership between providers and PHP
- Create policies and procedures to support LTSS providers
- Develop and perform training (internal and external) for LTSS providers
- Ensure timely completion of all required reports (internal and external)
- Execute leaderships vision of LTSS Provider Network
Benefits All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.
Wellness Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.
Why work at Presbyterian? As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.
About Presbyterian Healthcare Services Presbyterian exists to ensure the patients, members and communities we serve can achieve their best health. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees.
Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
Maximum Offer for this position is up to USD $42.63/Hr.
Compensation Disclaimer The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.
