Provider Contracting Manager jobs in Sumter, SC

LiveWell Choice, a subsidiary of Longevity Health, is growing and looking to hire an Advanced Practice Provider Clinical Manager - Sumter, SC.   

General Purpose: The individual holding this position is required to support and demonstrate their commitment to the Longevity Health Statement of Purpose, which is: To improve the health and quality of life of nursing home residents by caring for their unique medical, social, and emotional needs.

The Advanced Practice Provider Clinical Manager is responsible for overseeing all the day-to-day activities conducted by the clinical delivery providers working in the Longevity Health ISNP nursing facilities. This includes managing local facility relationships, engagement of nursing homes in the Longevity Health Model of Care, training and monitoring assigned Nurse Practitioner and Physician Assistant individuals and overall team performance. The Advanced Practice Provider Clinical Manager is responsible for overseeing, scheduling, and supporting a team of Nurse Practitioners and Physician Assistants to execute and deliver the Longevity Health Model of Care, Collaborative Primary Care, Health Plan Clinical Operations and Trusted Advisor/Member Advocate functions and improve the overall quality of care for LH members. The Advanced Practice Provider Clinical Manager works with Medical Director of Clinical Services (MDCS) to ensure clinical quality and affordability initiatives are executed effectively and targeted outcomes are achieved. The Advanced Practice Provider Clinical Manager may travel to broad geography, depending upon the market to visit nursing facilities and NP/PA/clinical team members.

Key Tasks and Responsibilities:

• Conduct rounds to each contracted nursing facilities on a regular basis to determine if contracted providers are delivering the Longevity Health Model of Care and are meeting quality and regulatory standards.
• Conducts periodic review meetings with contracted nursing facilities to review clinical and quality results of their ISNP residents’ care, discuss successes and opportunities for improvement and to promote open communication.
• Reviews daily clinical performance metrics and takes action if not on target.
• Provides coaching and coverage for clinical team members as needed PTO and time away from work.
• Conducts hospitalization reviews and identify root causes and provides coaching and feedback to facilities as part of the monthly clinical review meeting as well as Advanced Practice Providers.
• Facilitates Advanced Practice Providers (APPs - NPs and PAs) onboarding, hiring and conducts facility and clinical orientation.
• Ensures team performance to targeted goals.
• Builds effective nursing facility relationships to foster LH program success in the market.
• Works effectively with PCPs and other physicians.
• Ensures member care coordination activities are well managed including member transitions out of Nursing Facility to community care if needed.
• Escalates issues/concerns that may impact Longevity Health reputation, contract compliance, relationships or any state/regulatory laws/regulations or employment law.
• Works closely with Plan medical director is determining how to enhance/ improve provider quality and appropriateness of care to LH residents.
• Identifies learning needs of team and works with Director to address.
• Assists with Nursing Facility readiness assessments and ongoing education on Model of Care, and orientation.
• Completes HEDIS/STARs measures reports with APPs, and initiates actions.
• Maintain minimum weekly clinical update calls (currently much more frequent due to COVID) to facilitate interaction and information sharing with colleagues.
• Performs Chart audits as per MOC guidelines for Nurse Practitioners and provides feedback to APPs and MDCS if further interventions are needed for performance improvement.
• 1:1 with APPs on team and provides feedback to APPs, review APP scorecard and provides input on APPs performance appraisal to MDCS.
• Provides MOC oversight for all metrics and develops action plans for each metric and APP and provides education to APPs directly and follow- up to ensure compliance.
• Provides Coaching and 1:1 ACP Mentorship with RP/ family and Members ongoing.
• Provides daily coaching and case reviews with APPs on changes in condition and management of acute and chronic conditions to support Field APP practice.
• Provides APP member coverage for facility onboarding and PTO/sick time away from work as needed. Meets all APP job competencies.
• Provides oversight/coordination of prior authorizations.
• Facilitating MTM compliance and Communication to team of GAP reports.
• Initiates, tracks, updates APP employment requirements- TB test, Flu Shot, Licensure, Certification, DEA.
• Performs other related duties as assigned.

Licensure:

• State unrestricted licensed Advanced Practice Nurse, National Board certification (AANP or ANCC) as an Adult, Family, Geriatric or Primary Care nurse practitioner required. Will allow acute care nurse practitioner with nursing home/geriatric or hospice palliative experience OR state unrestricted licensed Physician’s Assistant NCCPA board certified with nursing home/geriatric or hospice/palliative experience.
• DEA License required.
• Must be eligible to participate in the Medicare program as a provider and registered.
• Valid state driver's license with a good driving record and proof of automobile insurance required.
• Auto liability insurance declaration page with minimum limits of $100,000/$300,000 for bodily injury and $100,000 for property damage with combined single limit of $300,000. You will be responsible for providing this proof of coverage on an annual basis. Newly onboarding employees to this job description should contact HR to discuss any adjustments required to meet this coverage.

Other:

• Must have an active national provider number (NPI) and an active Medicare provider number.

Education and Training:

• Master of Science in Nursing as a Nurse Practitioner from a nationally accredited program OR Master’s Degree from a nationally accredited program.

Knowledge and Experience:

• Minimum of three (3) years’ experience as an Advanced Practice Provider – Nurse Practitioner or Physician Assistant.
• One (1) year experience in a leadership role and one (1) year experience working in Nursing Facility is strongly preferred. Will consider experience working with similar population in another setting.
• Clinical background working in nursing homes or supervising staff in nursing homes or working with similar patient populations, clinical quality program implementation, utilization management program policies/procedures, working in a managed care plan with complex vulnerable populations.
• Knowledge and philosophical approach to managing patients by treating in most appropriate setting, based on their goals of care.
• Advanced care planning skills, palliative care knowledge.
• Successful experience in influencing a team of care delivery providers to get results.
• Knowledge of applicable State and Federal regulations, Medicare Advantage Institutional Special Needs Plans Model of Care, STARS-Quality Program requirements and other regulations, NCQA requirements.
• Computer proficiency, including Microsoft Office software, ability to learn and successfully utilize electronic medical records and other clinical software. Ability to compile and analyze data to be used for management, differentiation, and marketing purposes.
• Excellent verbal and written communication skills.
• Strong interpersonal skills a must to effectively enhance relationships with the communities we serve, including the internal organization. Excellent public presentation skills.
• Highly organized and able to manage multiple projects, people, and deadlines at one time.
• Able to work independently with minimal supervision getting results in a fast-paced environment.
• Ability and willingness to follow policies and procedures, work as a team member, supporting Health Plan programs and services, and represent Longevity Health in a positive professional manner.
• Computer competent- EMR experience, MS Office products, Excel, PPT, Word.

Company Overview:

Founded in 2018, Longevity Health started as an Institutional Special Needs Plan (ISNP), a type of Medicare Advantage health plan that addresses significant unmet needs of long-term institutionalized members who reside in nursing homes.  Through rapid growth from 2018 to 2022, we expanded our market footprint and currently offer ISNP Medicare Advantage plans in Colorado, Florida, Illinois, Michigan, New Jersey, New York, and North Carolina. 

In 2023, we expanded our service offerings to the broader health plan market.  In addition to our existing markets where we are both the ISNP and the care management team, we are now partnering with National Carriers on their offered ISNP plans in Ohio, Pennsylvania, upstate New York, Georgia, South Carolina, and Texas, with implementations in progress for several other additional US states. This allows us to utilize our core skills of supporting clinical post-acute needs of this vulnerable senior population Currently 13 markets and expanding rapidly.

Company Disclaimers:

Longevity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law.

It is the policy of Longevity Health to follow Federal and / or State regulations surrounding COVID vaccinations.  While CMS guidelines have been relaxed, there are some LHP facilities which will still require staff be vaccinated in an effort to protect the health of the members / patients we serve.  If your assigned location(s) require all staff to be fully vaccinated, you are required to obtain and / or provide documentation related to your COVID vaccination.  To confirm whether your assigned location(s) require COVID vaccinations, please refer to the Facility Guide Job Aid located on Longevity Health Plan’s intranet site. 

The Company will engage in an interactive process with individuals who cannot be vaccinated for medical or sincerely held religious beliefs to determine if a reasonable accommodation can be made. While an exemption/accommodation may be initially granted, if at any time during employment, it is determined that an exemption/accommodation that has been granted is no longer considered a reasonable accommodation, it can result in employment with the Company ending.

Candidates must meet the Company’s hiring criteria which include a pre-employment background and drug screening.

Longevity Health offers a competitive compensation and benefits package which includes medical, dental, vision, short and long-term disability, life insurance, and 401(k).

Submission of false information during the application process may result in immediate termination of employment without notice.