Network Relations Consultant Senior (Value-Based Program Specialist) – MyCare Ohio

Elevance Health • Columbus, OH

1d • Hybrid

About The Position

Network Relations Consultant Senior (Value-Based Program Specialist) – MyCare Ohio
The MyCare Ohio Plan program is to deliver high‐quality, trauma informed, culturally competent, person‐centered coordination for all members that addresses physical health, behavioral health, long term services and supports, and psychosocial needs. The Network Relations Consultant Senior (Value-Based Program Specialist) is responsible for and is fully dedicated to delivering on the LTSS commitment to linking provider payment to improved performance. This role will support the design and modification of Anthem VBP, based on stakeholder feedback and utilization.
How You Will Make an Impact Primary duties may include, but are not limited to: This associate will partner with Ohio Department of Medicaid (ODM), other LTSS contractors, and stakeholders to support the deployment of Value Based Payment methodologies for home and community-based services and long-term care nursing facility services, as well as to providers of other covered services, to meet provider needs and drive quality. In addition to advising on innovative programming for Anthem and supporting the VBPs, the role will be responsible for provider training, technical assistance, utilization, and performance monitoring related to the VBP offerings.

Requirements

• Requires a Bachelor's degree and a minimum of 5 years of customer service experience including 2 years’ experience as a Network Management Representative; or any combination of education and experience, which would provide an equivalent background.

Nice To Haves

• Prior experience as an LTSS or HCBS provider or in a provider office is preferred.
• Experience training or mentoring preferred.
• Value Based contracting/payment concepts experience preferred.
• Provider education experience preferred.
• Experience presenting to various levels of leadership strongly preferred.

Responsibilities

• Work collaboratively with stake holders to define key VBP performance indicators and deliver accurate and timely program performance to the providers as defined by program-specific requirements.
• Establish a core set of measures to be included in all provider feedback reports, standardized across all LTSS Contractors issuing the feedback reports.
• May be responsible for coordinating negotiated contracts for new and existing providers as needed.
• Functions as a high-level technical resource to resolve or facilitate complex provider issues.
• Coordinates Joint Operation Committees (JOC) of larger provider groups, driving the meetings in the discussion of issues and changes.
• Identifies and reports on provider utilization patterns which have a direct impact on quality-of-service delivery.
• Tracks and conduct provider refresher training as needed.
• Researches issues that may impact future provider negotiations or jeopardize network retention.
• Travels to worksite and other locations, as necessary.

Benefits

• In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees