Job Summary:

The Manager, Provider Relations-LTSS is responsible for overseeing and encouraging the collaboration with LTSS/HCBS providers and key stakeholders in the implementation of specific strategies for enhanced operational engagement, overall provider satisfaction, operational performance and compliance of the LTSS and HCBS provider network.

Essential Functions:

• Oversee the ownership of provider relationships through providing proactive, high-level account development and support to drive the overall satisfaction, engagement and retention of LTSS & HCBS provider network.
• Assists with the development and evolution of the team’s strategic direction, annual goals and objectives, recommends new processes and changes for increased department productivity ensuring goals and objectives are met.
• Ensure the ongoing training and development of Provider Relations Team to support LTSS and HCBS provider relationships; interview, select and train new team members.
• Collaborate with the Integrated Care’s business and technical architectures including Medicare, Medicaid, NCQA and other governing bodies.
• Oversee day to day operations and ensure compliance with program requirements and initiatives to drive CareSource, ODM, CMS, NCQA and State/Federal requirements and deliverables
• Lead in a matrixed environment, all resources, task planning and progress reporting related to LTSS network.
• Identify and manage risk, implement mitigation strategies and communicate/escalate to stakeholders.
• Establish and maintain strong working relationships with key internal and external business leaders.
• Manage issue resolution and escalation and ensure LTSS/HCBS Provider Relations team members are resolving complex, non-routine questions, issues, and problems timely, efficiently and effectively.
• Analyze current work processes, identify gaps and implement proactive, innovative approaches.
• Develop and report on key accomplishments and issues to leadership.
• Participate and collaborate in quality and cost savings initiatives.
• Develop, implement and manage an onboarding and education process.
• Outwardly support and communicate CareSource mission and goals.
• Ensure appropriate documentation of interactions and projects by all team members.
• Conduct team meetings to establish and execute on detailed tasks.
• Lead and manage the initiatives through their life cycle.
• Create and manage timelines (milestones) and task schedules.
• Collaborate with senior leadership to ensure initiatives are properly resourced and managed.
• Produce detailed reports and business decision documents.
• Provide clarification/verification for all levels regarding status/details.
• Incorporates effective change and risk management controls.
• Conduct performance management activities for direct reports, to include one-on-one meetings, performance appraisals, and discipline as appropriate.
• Perform any other job-related instructions as requested.

Education and Experience:

• Bachelor’s Degree in Business Administration, or related field or equivalent years of relevant experience is required.
• Minimum of five (5) years of experience in the health plan/managed care industry is required.
• Minimum of three (3) years of experience in Provider Relations is required.
• Advanced knowledge of Medicaid, Medicare, MyCare, LTSS, HCBS, and Ohio Home Care Waiver is required.
• Previous leadership/management experience is required.

Competencies, Knowledge and Skills:

• Proficient with Microsoft Office to include Word, Excel, and PowerPoint
• Excellent written and verbal communications skills
• Ability to develop, prioritize and accomplish goals.
• Detail oriented
• Strong interpersonal skills and high level of professionalism
• Effective listening and critical thinking skills
• Effective problem-solving skills with attention to detail
• Ability to work independently and within a team
• Strong negotiation skills
• Excellent leadership skills
• Ability to create and maintain excellent working relationships

Licensure and Certification:

• Employment in this position is conditional pending successful clearance of a driver’s license record check. If the driver’s license record results are unacceptable, the offer will be withdrawn or, if you have started employment in this position, your employment in this position will be terminated
• To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
• CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Mobile Worker: This is a mobile position, meaning that regular travel to different work locations is essential. Will be exposed to weather conditions typical of the location and may be required to stand and/or sit for long periods of time
• May be required to travel greater than 50% of time to perform work duties. A valid driver’s license, car, and insurance are necessary for work related travel
• Required to use general office equipment, such as a telephone, photocopier, fax machine, and personal computer
• Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our member and may refer members to other CareSource resources

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.