• Long Term Services and Support Representative

    Job Locations US-VA-Roanoke
    Job ID
    2018-4749
  • Overview

    Responsible for Virginia Premier for building and maintaining relationships long term care networks (including hospice care) to ensure adequacy, quality and access. Works with regional managers and Director to build relationships with skilled nursing facilities, hospice care, personal care, service facilitators, adult day care centers, home health agencies, community service boards and related network providers.

    Responsibilities

    • Primary responsibility to include developing and maintaining skilled nursing facilities, home health agencies, personal care providers, adult day care centers and related providers, and hospice care.
    • Works very closely with regional Manager and Director of LTSS to develop and manage strong relationships with providers of long term care services and supports.
    • Collaborates with VPHP medical management staff to assist long-term service and supports providers streamline and standardize current processes (i.e. payment, authorization, coordination of care).
    • Assists with the credentialing and re-credentialing process in accordance with company guidelines.
    • Provides prompt and efficient response to provider or provider-related issues with appropriate, objective documentation of concerns, recommendations for resolution, monitoring and re-evaluation.
    • In collaboration with senior management, oversees the development of new reimbursement and pay-for-performance models.
    • Assure compliance with operational policies and production standards that result in provider network adequacy and member retention.
    • Negotiate financial terms with providers in accordance with the parameters set by Senior Leadership
    • Responsible for leading relationship building efforts with long term services and support providers.
    • Performs site visits with LTSS community with an emphasis on identifying and resolving claims issues.
    • Develops and delivers presentations on the benefits of MLTSS and related programs to small and large provider audiences.
    • Identify and implement (upon approval) and process improvement activities.
    • Contribute to preparation, update and production of all marketing and educational materials/manuals.
    • Provides prompt and efficient response to provider or provider related issues with appropriate, objective documentation of concerns, recommendations for resolution, monitoring and re-evaluation.
    • Demonstrate comprehensive understanding of Department of Medical Assistance Services (DMAS) and Centers for Medicare and Medicaid Services (CMS) contractual requirements.
    • Extensive daily and some overnight travel required.

    Qualifications

     

     

    MINIMUM EDUCATION REQUIREMENTS

    • Bachelor’s Degree in Health Services, Business Administration or related business fields.
    • Master’s Degree in Healthcare Administration, Public Health or related field preferred

    SPECIAL KNOWLEDGE AND/OR SKILLS

    • Expertise in long term care services and supports
    • Knowledge of Home and Community Based Waiver services specifically Elderly and Disabled with Consumer Direction (EDCD) waiver
    • Demonstrated knowledge of reimbursement methodologies, managed care processes and Medicaid managed care business.
    • Ability to manage multiple projects while meeting deadlines and achieving business goals.
    • Proven presentation and written communication skills.
    • Ability to work independently 

    WORK BACKGROUND/EXPERIENCE

    • 5 years of experience in managed care contracting negotiations for all provider types.
    • Provider or payer experience in long term services and supports

    PHYSICAL REQUIREMENTS

    • Physical health sufficient to meet the ergonomic standards and demands of the position.

     

    About Us

     

    Virginia Premier is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs.  Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia. 

     

    We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.  

     

    Our mission is to inspire healthy living within the communities we serve!

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