Provider & Community Engagement Specialist

Ultipro; El Paso (TX); On-site; USD 60,000 - 90,000; Full time

Benefits offered by this job

Affordable Medical Insurance

Dental Insurance

Vision Insurance

Paid Time Off

Holidays

TeleDoc 24/7

Disability Plans

EAP

401K

Referral Bonus Program

Job summary

American Health Plans, a division of American Health Partners Inc., operates Institutional Special Needs Plans (I-SNPs) for seniors residing 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 full-time role offers benefits, including affordable medical/dental/vision insurance, generous paid time off, TeleDoc access, disability

Responsibilities

• Welcome all new members in accordance with established Plan processes
• Contracting providers and essential vendors in current service areas to maintain CMS adequacy and provide necessary services in the care of the Plan members
• Visit assigned members at least monthly
• Ensuring 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
• Develop and maintain relationships with key network providers, nursing home staff, and facilities within assigned region
• To conduct the education presentations of the Health Plan(s) providers to ensure their understanding and commitment with the Health Plan(s)
• Ongoing educational updates as prescribed by CMS and the Health Plan(s) policies
• Monitor, maintain and support provider relationships to ensure network coverage in all areas
• Annually sponsor or assist a minimum of one group activity at each regional nursing facilities
• Contact TruHealth staff or appointees at least monthly, but more often as appropriate, to discuss and ensure the needs of the Member and Plan are met
• Document all activities as required
• Follow up on any item(s) members are dissatisfied with and report to Plan accordingly
• Ensure all interactions with the members are compliant with CMS regulations
• Attend meetings as necessary

Education

Bachelor's degree

Job description

American Health Plans, a division of American Health Partners Inc., operates Institutional Special Needs Plans (I-SNPs) for seniors residing 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 full-time role offers benefits, including affordable medical/dental/vision insurance, generous paid time off, TeleDoc access, disability