Provider Network Development Specialist

Longevity Health is growing rapidly and is looking to add new talent to our team. Longevity Health Plan currently has operations in Colorado, Florida, Illinois, Michigan, New Jersey, New York, North Carolina, South Carolina, Georgia, Ohio, Texas, and Pennsylvania, with plans to start-up operations in other states in the very near future. Due to our rapid growth, we have an immediate need for a Provider Network Development Specialist.

General Purpose: The individual holding this position is required to support and demonstrate their commitment to the Longevity Health Statement of Purpose, which is: To improve the health and quality of life of nursing home residents by caring for their unique medical, social and emotional needs.

The Provider Network Development Specialist will work under the direction of the SVP and in collaboration with the Director of Provider Network Development, for the assigned Market. Key duties will include recruiting and contracting of providers identified by each participating Skilled Nursing Facility for participation in LH’s provider network in an accurate and timely manner to allow building operations to begin by identified go live dates. Once the Market is established and operational, work closely with the network team to optimize the provider network to allow for the delivery of the highest levels of quality care while maintaining an effective and affordable provider network. This position is a field-based position which will require the ideal candidate to live within the targeted Market and a willingness to travel to provider locations daily.

This position requires the employee to either live in the Market or be willing to travel extensively to the Market. Must be detail-oriented, possess exceptional communication and inter-personal and organizational skills and shall possess a willingness to go “above and beyond” as needed to complete daily tasks and/or projects accurately and on time. Must be able to multi-task, work in a fast-paced environment and abide to specific deadlines.

Key Tasks and Responsibilities:

Working under in collaboration with the Market implementation team teams, identify and contract with supplemental network providers.
Communicate to local Market teams updates regarding contracting efforts and results.
Coordinate the processing of demographic and provider roster changes submitted by providers.
Work with providers on the credentialing/re-credentialing process, including addressing provider questions and providing status updates when requested.
Educate providers regarding policies and procedures related to referrals and claims submission, provider portal education, and EDI submissions.
Assist each Regional Network Director in all contracting related issues and resolution.
Respond in a timely manner to physician inquiries regarding contracting requests.
Work closely with the consultants responsible for specialist and ancillary provider recruitment to ensure corporate and field teams are kept updated on their efforts and results.
Ensure welcome packets including welcome letters, quick reference guides and countersigned contracts are sent to providers timely.
Track credentialing across all Markets and ensure delegation audits are taking place as scheduled
Ensure adequate contracted ancillary services are in place to support each Market.
Track and share results on provider performance (e.g., utilization, unit cost opportunities, etc.) network performance for assigned Market.
Execute on special projects as assigned.
Support 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.
Performs other related duties as assigned.

Licensure:

Must have a valid state driver’s license with a good driving record and provide proof of insurance.

Education and Training:

High school diploma or equivalent.
Bachelor’s degree in healthcare related field preferred.

Knowledge and Experience:

3 plus years of healthcare industry experience with focus on provider relations, contracting and credentialing.
Knowledge of health care, managed care, Medicare and Medicaid.
Strong, effective communicator capable of navigating challenging conversations.
Excellent organizational, interpersonal, presentation, facilitation, and communication skills
Demonstrated commitment to high professional ethical standards.
Ability to adapt to a fast paced, continually changing business and work environment while managing multiple priorities.
Strong technical, analytical, and trouble-shooting skills.
Excellent follow-through skills; self-motivated and detail-oriented.
Strong organizational skills to manage multiple projects, issues, and priorities effectively and simultaneously, with attention to detail.
Intermediate to Expert level proficiency in the MS Office Suite (MS Word, Excel and Outlook).

Company Overview:

Founded in 2018, Longevity Health started as an Institutional Special Needs Plan (ISNP), a type of Medicare Advantage health plan that addresses significant unmet needs of long-term institutionalized members who reside in nursing homes. Through rapid growth from 2018 to 2022, we expanded our market footprint and currently offer ISNP Medicare Advantage plans in Colorado, Florida, Illinois, Michigan, New Jersey, New York, and North Carolina.

In 2023, we expanded our service offerings to the broader health plan market. In addition to our existing markets where we are both the ISNP and the care management team, we are now partnering with National Carriers on their offered ISNP plans in Ohio, Pennsylvania, upstate New York, Georgia, South Carolina, and Texas, with implementations in progress for several other additional US states. This allows us to utilize our core skills of supporting clinical post-acute needs of this vulnerable senior population Currently 13 markets and expanding rapidly.

Company Disclaimers:

Longevity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law.

It is the policy of Longevity Health to follow Federal and / or State regulations surrounding COVID vaccinations. While CMS guidelines have been relaxed, there are some LHP facilities which will still require staff be vaccinated in an effort to protect the health of the members / patients we serve. If your assigned location(s) require all staff to be fully vaccinated, you are required to obtain and / or provide documentation related to your COVID vaccination. To confirm whether your assigned location(s) require COVID vaccinations, please refer to the Facility Guide Job Aid located on Longevity Health Plan’s intranet site.

The Company will engage in an interactive process with individuals who cannot be vaccinated for medical or sincerely held religious beliefs to determine if a reasonable accommodation can be made. While an exemption/accommodation may be initially granted, if at any time during employment, it is determined that an exemption/accommodation that has been granted is no longer considered a reasonable accommodation, it can result in employment with the Company ending.

Candidates must meet the Company’s hiring criteria which include a pre-employment background and drug screening.

Longevity Health offers a competitive compensation and benefits package which includes medical, dental, vision, short and long-term disability, life insurance, and 401(k).

Submission of false information during the application process may result in immediate termination of employment without notice.