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!
- Generous paid time-off program and paid holidays for full time staff
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
- Establish a positive work environment that encourages participation in process improvement and commitment to department/company success
- 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
- Excellent computer skills, including Microsoft Office Suite
- Must be self-motivated, dependable, team and goal-oriented
- Prior experience in network development / network services is preferred
- Prior experience with acute and post-acute facilities is beneficial