Manager, Contracted Clinical Operations

Longevity Health Plan 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, 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 Manager, Contracted Clinical Operations.

Company Overview:
Longevity offers an integrated health plan care management platform designed to improve clinical outcomes and reduce unnecessary medical interventions for long-term care beneficiaries living in skilled nursing facilities (SNFs). We offer Institutional Special Needs Plans (I-SNP) that are designated Medicare Advantage plans targeted to beneficiaries with Medicare part A & B who require long-term care in institutional settings. Longevity provides an advanced practice practitioner (NP or PA) supported by LHP RNs and other LHP Clinical team members to work with facility staff, physicians, and caregivers to manage member care in place, and improve their clinical outcomes. I-SNP and the Advanced Practitioner Provider/Clinical Team will improve resident and family satisfaction by providing enhanced benefits specifically tailored to the needs of facility residents.

General Purpose: The individual holding this position is required to support and demonstrate their commitment to the Longevity Health Plan 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 Manager, Contracted Clinical Operations (MCCO) is accountable to ensure delegated functions to contracted providers/clinicians who are delegated for Model of Care or Health plan clinical delivery functions, are meeting CMS requirements set forth in the SNP Model of Care, HEDIS/STARs, and the Risk Adjustment program. The MCCO provides oversite for to up to 10 clinical delegates to ensure they deliver their delegated functions according to Longevity policies, procedures, and processes. The MCCO conducts pre-delegation audits to ensure delegates have the capability and capacity to take on delegated functions prior to delegating any functions to the delegate. in addition, the MCCO puts processes in place to routinely monitor delegate performance based on pre-defined metrics and if not meeting the metrics or Longevity requirements, takes action to remediate with the delegate. The MCCO is knowledgeable in the plan delegated functions and will serve as a resource to the delegate as well as Longevity. Ensures delegated clinical responsibilities for IPA market delegates meets Plan requirements.

Key Tasks and Responsibilities:

Works collaboratively with Network, Markets and Business Development teams to understand existing and new care and medical management contractors and ensure appropriate contracting terms, onboarding and delegation oversight are in place. Based on market feedback, recommends any changes in contract language as it relates to the execution of care and medical management responsibilities.
Participates in discussion with potential clinical delegates to understand delegate capabilities, overview of oversight process and regular performance review monitoring process.
Designs process to conduct pre delegation audits and executes with each new delegate and annually for existing delegates.
Works with Analytics and IT team to develop delegate performance scorecard and process to populate the scorecard inputs on a regular basis.
Ensures delegates are ready for onboarding including systems access, equipment as needed.
Meets regularly with RVPs to discuss delegate concerns, validates expectations, and works with delegates to comply.
Actively participates in delegate contracting and metrics/requirements including noting differences from Core to IPA markets. Ensures delegate contract languages addresses any identified issues as appropriate.
Schedules and leads delegate performance review meetings quarterly engaging network leader, appropriate RVP{s) and other relevant departments. Ensures if there are performance gaps that risk mitigation plans are in place and being reported regularly by the delegate.
Prepares delegate oversight summary reports and presents findings and recommendations to the Quality Committee at a minimum of annually but may be more often if there are ongoing issues with performance.
Ensures delegates are compliant with completing all mandatory Longevity Training
Appropriately escalates any compliance issues or concerns with the delegates.
Understands the delegates data needs and works with appropriate Longevity leaders to obtain support to meet their needs within the security, access, and controls policies of Longevity.
Understands and meets all delegate oversight responsibilities of NCQA and CMS
May need to travel occasionally for delegate meetings.
Reports delegate performance barriers and identifies solutions with the appropriate Longevity leader(s).
Performs other related duties as assigned.

Licensure:

Prefer Certified Case Manager, Healthcare Compliance Certification
Valid state driver’s license with a good driving record and proof of automobile insurance required.

Education and Training:

Minimum of bachelor’s degree required. Prefer healthcare related degree.

Knowledge and Experience:

Must have worked a minimum of 3 years in Medicare Advantage Plan preferable Special Needs Plan Care Management, Compliance, Internal Audit.
A minimum of two years health plan clinical audit experience (NCQA, Medicare Advantage-PHM)
Ability to communicate effectively verbally and in writing.
Organized and detail oriented, able to develop projects and manage data and reporting related to job responsibilities.
Has designed, led, or participated in several health plan PHM or related delegated oversight audits.
Has excellent conflict management skills.
A team player.
Must be a SME in delegated clinical functions auditing.
Computer and Microsoft user expert specifically PPT, Word, Excel.
Ability to build trust and positively influence others.
Critical thinker.
Effective Influencer.

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 Plan 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.

Longevity Health Plan offers 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.