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. This division currently operates in Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, Mississippi, Iowa, Idaho, Louisiana, and Indiana with planned expansion into other states in 2025. For more information, visit .
If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application!
Benefits and Perks include:
- Affordable Medical/Dental/Vision insurance options
- Generous paid time-off program and paid holidays for full time staff
- TeleDoc 24/7/365 access to doctors
- Optional short- and long-term disability plans
- Employee Assistance Plan (EAP)
- 401K retirement accounts with company match
- Employee Referral Bonus Program
POSITION SUMMARY :
The purpose of this position is to analyze assigned existing market needs, performs some standard contracting functions, educates providers and provider service entities, maintain business relationships for the Health Plan(s), reports on provider and market changes, acts as a support for other service areas for the Health Plan(s).
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
To work with and be involved in implementation as needed
Establish a positive work environment that encourages participation in process improvement and commitment to department/company success
Complete corporate assignments as assigned
Required Skills :
Must be fluent in all current provider payment methodologies including per diems, DRGs, and APCs
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
Must be able to work effectively in a team environment
Excellent computer skills, including Microsoft Office Suite
Must be self-motivated, dependable, team and goal-oriented
Required Work Experience :
Experience in the health care field required
Prior experience in network development / network services is preferred
Prior experience with acute and post-acute facilities is beneficial
Prior experience with Medicare Advantage plans is helpful
Licensing/Certification/Education Requirements :
Bachelor's degree preferred, but not required, with emphasis in Healthcare Administration/related field or three (3) years of experience in managed care network development/network services
Other Requirements :
Must be available to work 8 a.m. until 5 p.m. local time
Position requires travel to network provider locations in Pennsylvania.
Required Computer Software/Equipment Used :
Microsoft Suite including Outlook, Excel, and Word
Standard Office Equipment
Computer
Physical Requirements :
Allows discretion for standing, walking, sitting
Work is performed in a standard office environment; well-lit; comfortable temperature controlled; average conversational noise is frequent
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions
Required Safety Expectations :
Working safely and follow safety rules
Report unsafe working conditions and behaviors
Take reasonable and prudent actions to prevent others from engaging in unsafe practices
Supervisory Responsibilities :
Does not have direct supervisory responsibilities
Supervisor frequently determines priorities
Occasionally needs manager's direction due to extraordinary circumstances