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