Job Type
Full-time
Description
Culture Highlights!
- Telework environment – work from where it’s most convenient, home, office, etc.
- Flexible work model – flex your time to blend work and life to fit various lifestyles/needs.
- Monday through Friday schedule.
- 9 paid holidays, and 3 additional floating holidays (pro-rate applies).
- Volunteer in your community – 24 hours awarded annually.
- Professional Development – internal and external learning and development opportunities.
- Robust Total Rewards – Medical/Dental/Vision, Telehealth, Flex Spending, 401k Matching, Life insurance, LT/ST Disability, EAP, & Mileage Reimbursement.
- Eligible employer for Federal Public Service Loan Forgiveness Program.
**Hiring within Wisconsin only, most ideal within our service regions. Traveling and onsite required as needed.**
Position Summary:
The Provider Relations and Quality Manager is responsible for establishing and managing strong partnerships with new and existing nonresidential service providers, community agencies, and community representatives to ensure an adequate and high-quality provider network exists for Lakeland Care, Inc (LCI) Members. This is accomplished through development of an adequate and diverse provider network, establishing and monitoring service specific rate methodologies, and the ongoing evaluation of utilization and trends in community-based service contracts.
The Provider Relations and Quality Manager assists in coordinating and overseeing the quality of the organization’s provider network and all associated policies and procedures. It is responsible for the oversight of LCI’s provider credentialing and contracting process, and all quality control, process improvement, and written procedure associated.
The Provider Relations and Quality Manager will be multi-county in focus and partner closely with the Residential Services Manager, Care Management Program Managers, and the Provider Relations Senior Manager to ensure all LCI Residential Services staff communicate and practice a consistent and cohesive approach to providers and staff throughout LCI’s service regions. Role will manage and provide guidance to the Provider Quality Supervisor, Provider Credentialing Specialists, Provider Specialists, and the Provider Relations Assistant.
Responsibilities & Competencies:
- Recruit and oversee the onboarding of new providers and promote expansion within the existing network, specific to building community integration for members.
- Maintain and update the Provider Directory, oversee the review, monitoring, and updating of service codes as needed.
- Demonstrate understanding of Service Provider Contracting, regulatory requirements, the Department of Health Services (DHS) Family Care Contract, Service Rates, and ramifications of decisions.
- Review, monitor, and develop sustainable Rate Methodologies for nonresidential services.
- Strong interdivisional collaboration and communication including Quality and Care Management divisions related to needs of members, interpretation of data, and action steps required. Provide internal education and support on contracts, addendums, provider resources, and an enhance understanding of provider expertise.
- Maintain awareness of organizational interests and ensure that Service Provider Contracts include required elements and support LCI’s needs.
- Use cost and utilization data to drive decision making. Develop and analyze proactive indicators to address changing and emerging needs of members. Collaborate with internal stakeholders to identify innovative and original ideas to best serve members.
- Develop, implement, and revise a uniform credentialing process, provider filing system, and provider onboarding program.
- Assist in developing provider communications including the Provider Handbook, provider newsletters and Provider Network Advisory Committee.
- Coordinate activities with network and non-network providers to ensure availability of appropriate services. Ensure that natural community resources are available within the network.
- Interface with Division of Quality Assurance (DQA), review and ensure State of Deficiency (SOD) process and monitoring, and maintain contracting process.
- Ability to organize, facilitate, and contribute to LCI stakeholder and provider meetings/forums, and represent LCI at professional events (internal and external.)
- Maintain high productivity with poise and consistency while managing competing demands, vague assignments, interruptions, and distractions.
- Motivate and lead a high-performing team; attract, recruit, and retain employees while providing mentoring and professional development.
Are you excited about this role but not sure if your work experiences align to the role or qualifications? We encourage you to apply anyway. At Lakeland Care, our values drive how we do our work and how we hire. We strive to build an inclusive, authentic workforce that embraces diversity and differences in strengths. So be sure to highlight your skill set and competencies you’re confident in!
Requirements
- Bachelor’s degree in Accounting, Business, Social Work, Healthcare Administration, other related field, or equivalent combination of education and experience (includes knowledge, skills, and abilities).
- Minimum of six (6) years of leadership experience in the health care, long-term care, or health insurance industry. Two (2) to four (4) years of experience in contract negotiation supporting purchaser-provider business relationships, preferably in long-term care or acute and primary health care.
- Analytical skills in health care financial and utilization data.
- Knowledge of the service provider industry, subcontracting, and licensing and regulatory systems; and knowledge of provider network contracting in a managed care model preferred.
- Knowledge of federal and state rules and regulations of Medicaid/Medicaid waiver programs.
- Demonstrated knowledge of managed care principles.
- Demonstrated ability to read, analyze, and interpret business documents and advanced professional communications.
- Ability to work within time constraints and maintain attention to detail.
- Ability to respond effectively to sensitive inquiries and situations.
- Demonstrated ability to communicate with diverse segments of the general population and professional community.
- Excellent verbal and strong written communication skills are required.
- Outstanding organizational skills with the ability to juggle multiple responsibilities required.
- Experience, training, skills and/or aptitude in the following areas are desired: mediation and negotiations; analyzing and interpreting data for the purpose of strategic planning and system implementation; and addressing groups, administering training, and giving presentations.
- Current driver’s license, acceptable driving record and proof of adequate insurance required.
Acknowledgement:
This job posting describes the general nature and level of work performed by the individual assigned to this position and should not be interpreted as all inclusive and is subject to change by the employer as the needs of the employer and requirements of the position change.
APPLICATION DEADLINE DATE: Accepting through 4/23/24. Resume required.
For questions on this role, please reach out to the Talent Acquisition Specialist at Becky.Vang@lakelandcareinc.com.
**COMPENSATION CAN BE DISCUSSED WITH HUMAN RESOURCES.**
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Lakeland Care is a Wisconsin-based non-profit organization that focuses on creating a world we all want to live in. With long-standing roots as a managed care organization (MCO), we provide long-term care services through public and private care management to eligible elders and individuals with physical and intellectual or developmental disabilities. Additionally, we have branched out to provide organizational and professional development services to businesses within our communities. Our service offerings allow us to live our mission! Currently we serve members in 22 counties and have 10 offices in the Central to North East region of Wisconsin.
Our Mission
Empowering individuals. Strengthening communities. Inspiring futures.
Our Vision
To create a world we all want to live in.
Our Core Values
Kindness – We believe kindness is always possible and that no compassionate act is ever wasted.
Inclusion – We believe that open hearts and open minds are the only path to a brighter future.
Trust – We believe that honesty is still in style and that promises still have power.
We are an equal employment opportunity employer functioning under an Affirmative Action Plan. 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. We are an organization that participates in E-Verify.
