TruHealth

Role Description American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc., owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application! Essential Functions - Contracting providers and essential vendors in current service areas to maintain CMS adequacy and providing necessary services in the care of the Plan members. - Insuring providers and essential vendors in current service areas meet the credentialing requirements for their appropriate service lines. - Educating providers on the Health Plan(s) functions and roles in caring for its membership. - Ongoing educational updates as prescribed by CMS and the Health Plan(s) policies. - Conducting education presentations of the Health Plan(s) providers to ensure their understanding and commitment with the Health Plan(s). - Monitoring, maintaining and supporting provider relationships to ensure network coverage in all areas. - Working with and being involved in implementation as needed. - Establishing a positive work environment that encourages participation in process improvement and commitment to department/company success. - Completing corporate assignments as assigned. Qualifications - Must have knowledge and familiarity with all levels of medical services and ability to rapidly develop working relationships. - Must be able to accept instructions and work independently in the completion of goals and assignments. - Must have strong negotiation, organization, presentation and time management skills. - Must be able to effectively communicate with all levels of medical staff to explain Health Plan(s) program, benefits and goals. - Must be able to work effectively in a team environment. - Excellent computer skills, including Microsoft Office Suite. - Must be self-motivated, dependable, team and goal-oriented. Requirements - Experience in the health care field required. - Prior experience in network development / network services is preferred. - Prior experience with acute and post-acute facilities is beneficial. - Prior experience with Medicare Advantage plans is helpful. Licensing/Certification/Education Requirements - Bachelor’s degree. Other Requirements - Must be available to work 8 a.m. until 5 p.m. local time. - Position requires travel to network provider locations. - Teleworking is an option if criteria are met. Benefits - Affordable Medical/Dental/Vision insurance options. - Generous paid time-off program and paid holidays for full time staff. - TeleDoc 24/7/365 access to doctors. - Optional short- and long-term disability plans. - Employee Assistance Plan (EAP). - 401K retirement accounts. - Employee Referral Bonus Program. Equal Opportunity Employer Our Organization does not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. The Organization will also make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made. This employer participates in E-Verify.

Role Description American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc., owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application! Essential Functions - Contracting providers and essential vendors in current service areas to maintain CMS adequacy and providing necessary services in the care of the Plan members. - Insuring providers and essential vendors in current service areas meet the credentialing requirements for their appropriate service lines. - Educating providers on the Health Plan(s) functions and roles in caring for its membership. - Ongoing educational updates as prescribed by CMS and the Health Plan(s) policies. - Conducting education presentations of the Health Plan(s) providers to ensure their understanding and commitment with the Health Plan(s). - Monitoring, maintaining and supporting provider relationships to ensure network coverage in all areas. - Working with and being involved in implementation as needed. - Establishing a positive work environment that encourages participation in process improvement and commitment to department/company success. - Completing corporate assignments as assigned. Qualifications - Must have knowledge and familiarity with all levels of medical services and ability to rapidly develop working relationships. - Must be able to accept instructions and work independently in the completion of goals and assignments. - Must have strong negotiation, organization, presentation, and time management skills. - Must be able to effectively communicate with all levels of medical staff to explain Health Plan(s) program, benefits, and goals. - Must be able to work effectively in a team environment. - Excellent computer skills, including Microsoft Office Suite. - Must be self-motivated, dependable, team and goal-oriented. Requirements - Experience in the health care field required. - Prior experience in network development/network services is preferred. - Prior experience with acute and post-acute facilities is beneficial. - Prior experience with Medicare Advantage plans is helpful. Licensing/Certification/Education Requirements - Bachelor’s degree. Other Requirements - Must be available to work 8 a.m. until 5 p.m. local time. - Position requires travel to network provider locations. - Teleworking is an option if criteria are met. Benefits - Affordable Medical/Dental/Vision insurance options. - Generous paid time-off program and paid holidays for full-time staff. - TeleDoc 24/7/365 access to doctors. - Optional short- and long-term disability plans. - Employee Assistance Plan (EAP). - 401K retirement accounts. - Employee Referral Bonus Program. Equal Opportunity Employer Our Organization does not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. The Organization will also make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made. This employer participates in E-Verify.

Role Description To perform this job, an individual must perform each essential function satisfactorily with or without a reasonable accommodation: - Contracting providers and essential vendors in current service areas to maintain CMS adequacy and providing necessary services in the care of the Plan members. - Insuring providers and essential vendors in current service areas meet the credentialing requirements for their appropriate service lines. - Educating providers on the Health Plan(s) functions and roles in caring for its membership. - Ongoing educational updates as prescribed by CMS and the Health Plan(s) policies. - Conducting education presentations of the Health Plan(s) providers to ensure their understanding and commitment with the Health Plan(s). - Monitoring, maintaining and supporting provider relationships to ensure network coverage in all areas. - Working with and being involved in implementation as needed. - Establishing a positive work environment that encourages participation in process improvement and commitment to department/company success. - Completing corporate assignments as assigned. Qualifications - Must have knowledge and familiarity with all levels of medical services and ability to rapidly develop working relationships. - Must be able to accept instructions and work independently in the completion of goals and assignments. - Must have strong negotiation, organization, presentation and time management skills. - Must be able to effectively communicate with all levels of medical staff to explain Health Plan(s) program, benefits and goals. - Must be able to work effectively in a team environment. - Excellent computer skills, including Microsoft Office Suite. - Must be self-motivated, dependable, team and goal-oriented. Requirements - Experience in the health care field required. - Prior experience in network development / network services is preferred. - Prior experience with acute and post-acute facilities is beneficial. - Prior experience with Medicare Advantage plans is helpful. - Bachelor’s degree. - Must be available to work 8 a.m. until 5 p.m. local time. - Position requires travel to network provider locations. - Teleworking is an option if criteria are met. Benefits - Affordable Medical/Dental/Vision insurance options. - Generous paid time-off program and paid holidays for full time staff. - TeleDoc 24/7/365 access to doctors. - Optional short- and long-term disability plans. - Employee Assistance Plan (EAP). - 401K retirement accounts. - Employee Referral Bonus Program. Company Description American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc., owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations.

Role Description To perform this job, an individual must perform each essential function satisfactorily with or without a reasonable accommodation: - Contracting providers and essential vendors in current service areas to maintain CMS adequacy and providing necessary services in the care of the Plan members. - Insuring providers and essential vendors in current service areas meet the credentialing requirements for their appropriate service lines. - Educating providers on the Health Plan(s) functions and roles in caring for its membership. - Ongoing educational updates as prescribed by CMS and the Health Plan(s) policies. - Conducting education presentations of the Health Plan(s) providers to ensure their understanding and commitment with the Health Plan(s). - Monitoring, maintaining and supporting provider relationships to ensure network coverage in all areas. - Working with and being involved in implementation as needed. - Establishing a positive work environment that encourages participation in process improvement and commitment to department/company success. - Completing corporate assignments as assigned. Qualifications - Must have knowledge and familiarity with all levels of medical services and ability to rapidly develop working relationships. - Must be able to accept instructions and work independently in the completions of goals and assignments. - Must have strong negotiation, organization, presentation and time management skills. - Must be able to effectively communicate with all levels of medical staff to explain Health Plan(s) program, benefits and goals. - Must be able to work effectively in a team environment. - Excellent computer skills, including Microsoft Office Suite. - Must be self-motivated, dependable, team and goal-oriented. Requirements - Experience in the health care field required. - Prior experience in network development / network services is preferred. - Prior experience with acute and post-acute facilities is beneficial. - Prior experience with Medicare Advantage plans is helpful. - Bachelor’s degree. - Must be available to work 8 a.m. until 5 p.m. local time. - Position requires travel to network provider locations. - Teleworking is an option if criteria are met. Benefits - Affordable Medical/Dental/Vision insurance options. - Generous paid time-off program and paid holidays for full time staff. - TeleDoc 24/7/365 access to doctors. - Optional short- and long-term disability plans. - Employee Assistance Plan (EAP). - 401K retirement accounts. - Employee Referral Bonus Program. Company Description American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc., owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations.

Role Description The purpose of this position is to provide lead level support to the Appeals and Grievances team with the direct assistance of the Director of Claims Operations. This includes overseeing the processing, tracking, and following up on all medical necessity and administrative denials, appeals, grievances, and disputes for Medicare Advantage members in accordance with Medicare guidelines and regulations. The Appeals and Grievances Team Leader is a critical team player who works in a fast-paced, ever-changing environment with a passionate team and must deliver daily. Essential Functions - Capture, investigate and respond to all complaints regarding customer grievances and appeals. - Oversee claim payment disputes provision of service and benefit coverage issues. - Conduct pertinent research to evaluate, answer, and close appeals. - Ensure appropriate resolution to inquiries, grievances and appeals within specified timeframes established by regulatory/accreditation agencies or customer needs. - Assist members when filing appeals; educate members, document and route the information appropriately. - Prepare response letters, notifications, and acknowledgements for members and provider complaints, grievances and appeals. - Maintain grievance information and supporting documentation in accordance with all state, federal, NCQA, URAC and other regulatory agency standards/regulations. - Escalate issues appropriately or work with other departments to resolve member issues. - Ensure all HIPAA and State requirements/regulations are always adhered to. - Identify issues and root causes of appeals and disputes for plan management and compliance. - Identify and report trends and/or areas of opportunities to supervisor. - Maintain and update appeal and grievance policies and procedures, member correspondence materials, and process manuals. - Perform internal audits of grievance and appeals process. - Maintain privacy and confidentiality of records, conditions, and other information relating to residents, employees and facility. - Encourage an atmosphere of optimism, warmth and interest in patients’ personal and health care needs. - Meet critical time frames on a frequent and regular basis. Qualifications - Excellent communication skills and active listening. - Positive, engaging customer service skills. - Ability to work cooperatively with internal departments and external stakeholders. - Ability to perform in potentially stressful situations, such as state, federal, NCQA, URAC or other regulatory/accrediting agency audits. Requirements - Minimum (3) three years’ health plan experience; insurance, compliance, managed care, or quality assurance preferred. - Minimum (3) years of Grievance and appeals experience preferred, specifically within a Medicare and/or Medicare Advantage context. - Minimum two years of demonstrated leadership skills in claims and/or appeals and grievances. - Proven track record for improving processes and problem-solving skills. - Ability to motivate team members while also possessing strong leadership skills. - Experience working with physicians and clinicians in the appeals and grievance space, preferred. - Knowledge and understanding of complaint and appeal procedures. - Knowledge of managed care, particularly utilization management processes. - Knowledge of NCQA, HEDIS or general accreditation requirements and guidelines for utilization management, denials and appeals. - Familiarity with Appeals processes and regulatory requirements related to customer service experience. - Proven ability to problem-solve and make solid and well-researched decisions. - Qualifying criminal background. Education Requirements - High school diploma required. - Associates degree preferred. - Successfully completed college courses in relevant fields to compensate for experience preferred. - Medicare experience preferred.

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application! Benefits and Perks include: - Affordable Medical/Dental/Vision insurance options - Generous paid time-off program and paid holidays for full time staff - TeleDoc 24/7/365 access to doctors - Optional short- and long-term disability plans - Employee Assistance Plan (EAP) - 401K retirement accounts - Employee Referral Bonus Program ESSENTIAL FUNCTIONS: To perform this job, an individual must perform each essential function satisfactorily with or without a reasonable accommodation • Contracting providers and essential vendors in current service areas to maintain CMS adequacy and providing necessary services in the care of the Plan members • Insuring providers and essential vendors in current service areas meet the credentialing requirements for their appropriate service lines • Educating providers on the Health Plan(s) functions and roles in caring for its membership • Ongoing educational updates as prescribed by CMS and the Health Plan(s) policies • To conduct the education presentations of the Health Plan(s) providers to insure their understanding and commitment with the Health Plan(s) • Monitor, maintain and support provider relationships to insure network coverage in all areas • To work with and be involved in implementation as needed • Establish a positive work environment that encourages participation in process improvement and commitment to department/company success • Complete corporate assignments as assigned Required Skills: • Must have knowledge and familiarity with all levels of medical services and ability to rapidly develop working relationships • Must be able to accept instructions and work independently in the completions of goals and assignments • Must have strong negotiation, organization, presentation and time management skills • Must be able to effectively communicate with all levels of medical staff to explain Health Plan(s) program, benefits and goals • Must be able to work effectively in a team environment • Excellent computer skills, including Microsoft Office Suite • Must be self-motivated, dependable, team and goal-oriented Required Work Experience: • Experience in the health care field required • Prior experience in network development / network services is preferred • Prior experience with acute and post-acute facilities is beneficial • Prior experience with Medicare Advantage plans is helpful Licensing/Certification/Education Requirements: • Bachelor’s degree Other Requirements: • Must be available to work 8 a.m. until 5 p.m. local time • Position requires travel to network provider locations. • Teleworking is an option if criteria are met EQUAL OPPORTUNITY EMPLOYER Our Organization does not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. The Organization will also make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made. This employer participates in E-Verify.

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. This division currently operates in Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, Mississippi, Iowa, Idaho, Louisiana, and Indiana with planned expansion into other states in 2025. For more information, visit AmHealthPlans.com. If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application! Benefits and Perks include: - Affordable Medical/Dental/Vision insurance options - Generous paid time-off program and paid holidays for full time staff - TeleDoc 24/7/365 access to doctors - Optional short- and long-term disability plans - Employee Assistance Plan (EAP) - 401K retirement accounts with company match - Employee Referral Bonus Program Position Summary: The Member Advocate is a customer-service focused position that will support local service areas. This role reports to the Program Manager of their specific work region. The position is considered a work-from-home position as no formal office space/work location is provided; however, the Member Advocate will conduct a large portion of his/her work within partner nursing homes within a specific work region. Essential Functions: - Member Advocate will welcome all new members in accordance with established Plan processes. - Once member is enrolled, follow up member to ensure that any questions are answered, act as a point of contact if the member or their family needs assistance with the plan, or provide them with periodic updates about the plan. - Act as front-line support as needed with the member, partner facility and integrated care team to ensure the needs of the Member and Plan are met. - Develop and maintain relationships with key network providers/facilities within assigned region; support continued regional network development activities necessary to meet network adequacy requirements. - Meet with the member and/or their family at least monthly. - Member Advocates will annually sponsor or assist with no less than one group activity at each of their regional nursing facilities. - Contact TruHealth staff or appointees at least monthly, but more often as appropriate, to discuss and ensure the needs of the Member and Plan are met. - Follow up on any items that the members are dissatisfied with and report to plan accordingly. - Develop and maintain reporting to include but not limited to managing member status, daily/weekly/monthly facility calendar, issues tracking/management. - Ensure that ALL interactions with the member are compliant with CMS regulations. - Other responsibilities as assigned. Required Work Experience: - Experience successfully working in a healthcare delivery setting with elderly patients as either a clinician, social worker or caregiver. Nursing home experience is preferred. - CMS regulations regarding Medicare Advantage Plans Other Requirements: - Exceptional interpersonal skills with demonstrated ability to work independently as well as with a team; must be a good listener to understand feedback raised by the family. - Compliant, at all times, with CMS regulations regarding Medicare Advantage Plans. - Ability to work well with staff at each of the nursing homes in the assigned region to include nursing staff, doctors and administration staff. - Ability to deliver outstanding customer service with a proven track record. - Exceptional organizational skills - Strong written and verbal communication and clear-thinking skills with the ability to synthesize complex issues into simple messages. - Willingness and ability to travel to facilities within your assigned region; have dependable transportation, a current driver’s license, a clean driving record, and proof of insurance. - Strong proficiency in computer skills in Microsoft Office Suite products. - Have suitable home work space allowing for productive office environment. License/Certification/Education Required: - Current Driver's License in applicable state - Associate Degree preferred EQUAL OPPORTUNITY EMPLOYER Our Organization does not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. The Organization will also make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made. This employer participates in E-Verify.

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application! Benefits and Perks include: - Affordable Medical/Dental/Vision insurance options - Generous paid time-off program and paid holidays for full time staff - TeleDoc 24/7/365 access to doctors - Optional short- and long-term disability plans - Employee Assistance Plan (EAP) - 401K retirement accounts - Employee Referral Bonus Program ESSENTIAL FUNCTIONS: To perform this job, an individual must perform each essential function satisfactorily with or without a reasonable accommodation • Contracting providers and essential vendors in current service areas to maintain CMS adequacy and providing necessary services in the care of the Plan members • Insuring providers and essential vendors in current service areas meet the credentialing requirements for their appropriate service lines • Educating providers on the Health Plan(s) functions and roles in caring for its membership • Ongoing educational updates as prescribed by CMS and the Health Plan(s) policies • To conduct the education presentations of the Health Plan(s) providers to insure their understanding and commitment with the Health Plan(s) • Monitor, maintain and support provider relationships to insure network coverage in all areas • To work with and be involved in implementation as needed • Establish a positive work environment that encourages participation in process improvement and commitment to department/company success • Complete corporate assignments as assigned Required Skills: • Must have knowledge and familiarity with all levels of medical services and ability to rapidly develop working relationships • Must be able to accept instructions and work independently in the completions of goals and assignments • Must have strong negotiation, organization, presentation and time management skills • Must be able to effectively communicate with all levels of medical staff to explain Health Plan(s) program, benefits and goals • Must be able to work effectively in a team environment • Excellent computer skills, including Microsoft Office Suite • Must be self-motivated, dependable, team and goal-oriented Required Work Experience: • Experience in the health care field required • Prior experience in network development / network services is preferred • Prior experience with acute and post-acute facilities is beneficial • Prior experience with Medicare Advantage plans is helpful Licensing/Certification/Education Requirements: • Bachelor’s degree Other Requirements: • Must be available to work 8 a.m. until 5 p.m. local time • Position requires travel to network provider locations. • Teleworking is an option if criteria are met EQUAL OPPORTUNITY EMPLOYER Our Organization does not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. The Organization will also make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made. This employer participates in E-Verify.

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application! Benefits and Perks include: - Affordable Medical/Dental/Vision insurance options - Generous paid time-off program and paid holidays for full time staff - TeleDoc 24/7/365 access to doctors - Optional short- and long-term disability plans - Employee Assistance Plan (EAP) - 401K retirement accounts - Employee Referral Bonus Program ESSENTIAL FUNCTIONS: To perform this job, an individual must perform each essential function satisfactorily with or without a reasonable accommodation • Contracting providers and essential vendors in current service areas to maintain CMS adequacy and providing necessary services in the care of the Plan members • Insuring providers and essential vendors in current service areas meet the credentialing requirements for their appropriate service lines • Educating providers on the Health Plan(s) functions and roles in caring for its membership • Ongoing educational updates as prescribed by CMS and the Health Plan(s) policies • To conduct the education presentations of the Health Plan(s) providers to insure their understanding and commitment with the Health Plan(s) • Monitor, maintain and support provider relationships to insure network coverage in all areas • To work with and be involved in implementation as needed • Establish a positive work environment that encourages participation in process improvement and commitment to department/company success • Complete corporate assignments as assigned Required Skills: • Must be fluent in all current provider payment methodologies including per diems, DRGs, and APCs • Must have knowledge and familiarity with all levels of medical services and ability to rapidly develop working relationships • Must be able to accept instructions and work independently in the completions of goals and assignments • Must have strong negotiation, organization, presentation and time management skills • Must be able to effectively communicate with all levels of medical staff to explain Health Plan(s) program, benefits and goals • Must be able to work effectively in a team environment • Excellent computer skills, including Microsoft Office Suite • Must be self-motivated, dependable, team and goal-oriented Required Work Experience: • Experience in the health care field required • Prior experience in network development / network services is preferred • Prior experience with acute and post-acute facilities is beneficial • Prior experience with Medicare Advantage plans is helpful Licensing/Certification/Education Requirements: • Bachelor’s degree Other Requirements: • Must be available to work 8 a.m. until 5 p.m. local time • Position requires travel to network provider locations. • Teleworking is an option if criteria are met EQUAL OPPORTUNITY EMPLOYER Our Organization does not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. The Organization will also make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made. This employer participates in E-Verify.

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application! Benefits and Perks include: - Affordable Medical/Dental/Vision insurance options - Generous paid time-off program and paid holidays for full time staff - TeleDoc 24/7/365 access to doctors - Optional short- and long-term disability plans - Employee Assistance Plan (EAP) - 401K retirement accounts - Employee Referral Bonus Program ESSENTIAL FUNCTIONS: To perform this job, an individual must perform each essential function satisfactorily with or without a reasonable accommodation • Contracting providers and essential vendors in current service areas to maintain CMS adequacy and providing necessary services in the care of the Plan members • Insuring providers and essential vendors in current service areas meet the credentialing requirements for their appropriate service lines • Educating providers on the Health Plan(s) functions and roles in caring for its membership • Ongoing educational updates as prescribed by CMS and the Health Plan(s) policies • To conduct the education presentations of the Health Plan(s) providers to insure their understanding and commitment with the Health Plan(s) • Monitor, maintain and support provider relationships to insure network coverage in all areas • To work with and be involved in implementation as needed • Establish a positive work environment that encourages participation in process improvement and commitment to department/company success • Complete corporate assignments as assigned Required Skills: • Must have knowledge and familiarity with all levels of medical services and ability to rapidly develop working relationships • Must be able to accept instructions and work independently in the completions of goals and assignments • Must have strong negotiation, organization, presentation and time management skills • Must be able to effectively communicate with all levels of medical staff to explain Health Plan(s) program, benefits and goals • Must be able to work effectively in a team environment • Excellent computer skills, including Microsoft Office Suite • Must be self-motivated, dependable, team and goal-oriented Required Work Experience: • Experience in the health care field required • Prior experience in network development / network services is preferred • Prior experience with acute and post-acute facilities is beneficial • Prior experience with Medicare Advantage plans is helpful Licensing/Certification/Education Requirements: • Bachelor’s degree Other Requirements: • Must be available to work 8 a.m. until 5 p.m. local time • Position requires travel to network provider locations. • Teleworking is an option if criteria are met EQUAL OPPORTUNITY EMPLOYER Our Organization does not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. The Organization will also make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made. This employer participates in E-Verify.