Long Term Support Services (LTSS) and Dental Provider Liaison

Job Locations US-CA-Fairfield | US-CA-Eureka | US-CA-Redding | US-CA-Santa Rosa
Job ID
2024-2875
FLSA Status
Exempt
Hiring Range
$ 72,067.77 - $ 93,687.81

Overview

To Act as a Long Term Services and Supports (LTSS) Provider Liaison-Long Term Care
Facilities and Skilled Nursing Facilities (SNF) and a Dental Liaison: including the responsibility
of collaborating with internal departments to identify process improvement and maintaining
consistent knowledge of benefit changes from the Department of Health Care Services.

Responsibilities

  • Assists providers and facilities with transitions of care to support the member’s needs.
  • Serves as a point of contact for LTSS and Dental providers at the health plan to address
    questions for payment, claims and/or Partnership contract language.
  • Coordinates with clinical staff within Health Services to address authorization, care
    coordination, and/or transitional care needs for Partnership members.
  • Maintains benefit standardization and surface issues or questions to the appropriate staff
    for process improvement.
  • Provides education to providers regarding availability of community resources and how
    to access these resources.
  • Identifies learning opportunities for hospitals, providers and/or topics for community
    partners.
  • Progresses new strategic partnerships with key stakeholders and identifies opportunities
    to expand outreach and educational efforts Collaborates with Partnership’s Quality
    department to support new and ongoing quality programs that impact LTSS providers
    such as the Quality Assurance and Performance Improvement (QAPI).
  • Works in conjunction with internal counterparts to proactively support network
    performance and process improvement.
  • Develops structures, relationships, and processes to promote active partnerships with
    providers, community stakeholders, and/or other healthcare professionals to meet and
    support key organizational initiatives (ex: county partners, hospitals, DME vendors,
    skilled facilities, CBAS centers, ECM/CS providers, etc.)
  • Stays informed of changes related to benefits, regulations and/or Partnership policies
    related to LTSS and Dental services.
  • Receives training on the full spectrum of rules, regulations, policies and procedures
    pertaining to Medi-Cal covered Long Term Care (LTC), including:
  • Payment and coverage
  • Prompt claims payment requirements
    • Provider resolution
    • Care management
    • Care coordination
    • Transition of care
  • Disseminates their contact information to relevant LTSS, SNF, LTC and Dental Network
    Providers.
  • Other duties as assigned.

Qualifications

 

 

Education and Experience

Bachelor’s degree in Business Administration, Business Management,
Computer Science or relevant field and at least one (1) year of relevant
program management experience required. In lieu of degree, a
minimum of three (3) years of relevant experience to include a
minimum of two (2) years program management experience will be
considered.

 

 

Special Skills, Licenses and Certifications

Critical thinking, strong organization skills with ability to prioritize
assignments and manage time effectively. Effective communication
skills, both verbal and written, to interpret and articulate program
requirements to involved stakeholders. Excellent attention to detail.
Working knowledge of project/program management methodologies
required. Valid California driver’s license and proof of current
automobile insurance compliant with PHC policy are required to
operate a vehicle and travel for company business.

 

 

 

Performance Based Competencies

Knowledge of business practices and protocols with ability to access
data and information using automated systems. Ability to participate in
team based projects. Strong organizational skills with ability to
prioritize assignments and maintain effective filing systems and meet
deadlines. Strong attention to detail; critical thinking/listening and
communication skills.

 

 

 

Work Environment And Physical Demands

More than 50% of work time is spent using a computer. Ability to lift,
carry, or move objects of varying size, weighting up to 25 lbs. Must be
able to work in a fast-paced environment and maintain courtesy and
composure when dealing with internal and external customers. Ability
to function effectively with frequent interruptions and direction from
multiple team members.

 

 

 

All HealthPlan employees are expected to:

 

  • Provide the highest possible level of service to clients;
  • Promote teamwork and cooperative effort among employees;
  • Maintain safe practices; and
  • Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

HIRING RANGE:

 

$ 72,067.77 - $ 93,687.81

 

IMPORTANT DISCLAIMER NOTICE

 

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

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