• Director, Member Acquisition

    Location US-NY-New York
    Posted Date 4 weeks ago(5/24/2018 8:26 AM)
    Job ID
    2018-11789
    # Positions
    1
    Facility
    ArchCare Community Life
    Experience (Years)
    5
    Category
    Care Management
    Work Days Per Week
    5
    Shift
    D
    Shift Start Time
    9:00am
    Shift End Time
    5:00pm
    Type
    Full-Time
    # Hours
    35
  • Overview

    Individual is responsible for all activities related to the clinical assessment for enrollment and ongoing enrollment in the MLTC, coordinating the development and maintenance of a comprehensive provider network and provider relations with the Director of Network Development and ensuring the entire member on-boarding process is efficient and timely. In this role, the employee serves as the Plan’s liaison to all providers and MAXIMUS on all matters related to referral acquisition and enrollment into ACL.

    Responsibilities

    • In collaboration with the Vice President, plan and implementation a member acquisition strategy for ArchCare Community Life (MLTCP).
    • Performs ongoing provider gap analysis, and continually analyzes network needs. Recommends providers to the Director of Network Development to help ensure a network sufficient to support membership of the plan.
    • Oversight of the daily operations related to Assessments completed by RN’s for potential/current members for the MLTC product
    • Provides monthly data to demonstrate Assessment Team activities and/or perform ad hoc data investigation.
    • Manages work of all delegated/vendor agencies including communicating changes in workflow, regulations, issuing CAP’s and Invoice processing
    • Develops and maintains UAS, marketing and enrollment policies and procedures.
    • In collaboration with the VP and Director of Network Development identifies cost improvement opportunities and assists in the development and maintenance of key provider pricing strategies that contribute to the management of overall medical costs.
    • Works collaboratively with key stakeholders and partners at the plan and system level including Legal, Medical Management, Finance, Claims, Customer Services, Regulatory Affairs, Enrollment and Marketing.
    • Supervises UAS Team, Sale/Marketing, Enrollment and Entitlement staff to meet departmental goals.
    • Manages daily operations of the assigned departments.
    • Review, research, investigate and correct enrollment issues, document and present findings to VP.
    • Develop, maintain and update spreadsheets, data bases and EMR for traceability of all referrals, enrollment and disenrollment submissions.
    • Review and analyze contract changes that impact the enrollment process.
    • Assist the VP in the development of user documentation and process workflows as well as policies and procedures.
    • Develop and maintain excellent relationships with internal and external customers.
    • Attend meetings and training programs with Federal and State agencies.
    • Provider/Vendor oversight for all external parties.
    • Monitor the Medicaid re-certification process to ensure the contracted vendor handling the process in a timely manner.
    • Ensure documentation to City, State and Federal agencies is submitted timely.
    • Respond to and resolve any questions/issues from prospective enrollees or their families.
    • Keep up to date on Medicare and Medicaid program changes and share information with staff and internal departments.
    • Serve as subject matter expert for enrollment, UAS and sales/marketing.
    • Review and determine areas of improvement within the department and present to VP.
    • Develop and lead prospective member referral process; maintain existing referral sources and develop new sources.
    • Develops and provides presentations to the community, groups and individuals
    • Participate in the implementation of a ACL Marketing Plan
    • Develop a strategy to meet or exceed the enrollment goals for ACL.
    • Work with the interdisciplinary team to continually look for ways to streamline and improve the member on-boarding process and the new member welcome experience.
    • Ensure that all prospective member inquiries are responded to promptly.
    • Identify new opportunities for marketing outreach and growth.
    • Performs other related duties, as required.

     

    Qualifications

    Education & Experience

    Formal Education: Bachelor's Degree in Nursing

    Experience: 5 years

    Minimum Knowledge: Requires extensive knowledge in several specialized disciplines and ability to integrate critical information from many diverse areas. Requires extensive theoretical and practical knowledge.

    Language Ability: Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, providers, customers, and the general public.

    Education Requirements

    Bachelor’s Degree in business and/or health care administration or a related area of study with business experience.

    Experience Requirements

    • Experience with a frail and/or elderly population
    • Current knowledge of managed care and best practices.
    • Healthcare operations and management skills.
    • Ability to manage, prioritize and delegate to others accordingly.
    • Ability to handle conflict and confront challenging issues in a fast paced work environment.
    • General knowledge of State and Federal regulatory requirements related to plan operations.
    • Excellent oral and written communication skills including the ability to communicate both simple and complex terms at different organizational levels.
    • Establish good working relationships with Network Providers, Federal and State agency contacts.
    • Training of new staff on operational procedures and compliance methodology and changes.
    • Experience in health care marketing or sales preferred.
    • Experience in managed care enrollment preferred.

     

    Skill Requirements

    Extensive knowledge of the UAS process, provider networks, marketing and the MAXIMUS enrollment process. Knowledge of Medicare/Medicaid programs and reimbursement methodologies. Knowledge and understanding of hospital and managed care financing. Excellent oral and written communication skills including the ability to communicate both simple and complex terms at different organizational levels. Strong organizational and analytical skills. Enhanced ability to maintain positive relationships with all internal and external customers. Good reasoning abilities, and ability to use sound judgment in all decision making situations. Resourceful and well-organized, capable of launching and managing complex projects

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