Network Relations Consultant Senior (Value-Based Program Specialist) MyCare Ohio

Network Relations Consultant Senior (Value-Based Program Specialist)

Be part of an extraordinary team. The MyCare Ohio Plan program is to deliver high quality, trauma informed, culturally competent, person-centered coordination for all members that addresses physical health, behavioral health, long term services and supports, and psychosocial needs.

This position is based in Ohio; the associate will report to one of our four office locations below:

• 3075 Vandercar Way, Cincinnati, OH 45209
• 8940 Lyra Drive, STE 300, Columbus, OH 43240
• 4361 Irwin Simpson Road, Mason, OH 45040
• 6000 Lombardo Center, STE 200, Seven Hills, OH 44131

In Office Expectation: Hybrid 1; This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Shift & Hours: Monday-Friday, 8:00 AM - 5:00 PM Eastern Time.

The Network Relations Consultant Senior (Value-Based Program Specialist) is responsible for and is fully dedicated to delivering on the LTSS commitment to linking provider payment to improved performance. This role will support the design and modification of Anthem VBP, based on stakeholder feedback and utilization.

How You Will Make an Impact:

• This associate will partner with Ohio Department of Medicaid (ODM), other LTSS contractors, and stakeholders to support the deployment of Value Based Payment methodologies for home and community-based services and long-term care nursing facility services, as well as to providers of other covered services, to meet provider needs and drive quality.
• In addition to advising on innovative programming for Anthem and supporting the VBPs, the role will be responsible for provider training, technical assistance, utilization, and performance monitoring related to the VBP offerings.
• Work collaboratively with stakeholders to define key VBP performance indicators and deliver accurate and timely program performance to the providers as defined by program-specific requirements.
• Establish a core set of measures to be included in all provider feedback reports, standardized across all LTSS Contractors issuing the feedback reports.
• May be responsible for coordinating negotiated contracts for new and existing providers as needed.
• Functions as a high-level technical resource to resolve or facilitate complex provider issues.
• Coordinates Joint Operation Committees (JOC) of larger provider groups, driving the meetings in the discussion of issues and changes.
• Identifies and reports on provider utilization patterns which have a direct impact on quality-of-service delivery.
• Tracks and conduct provider refresher training as needed.
• Researches issues that may impact future provider negotiations or jeopardize network retention.
• Travels to worksite and other locations, as necessary.

Minimum Requirements:

• Requires a Bachelor's degree and a minimum of 5 years of customer service experience including 2 years' experience as a Network Management Representative; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, & Experiences:

• Prior experience as an LTSS or HCBS provider or in a provider office is preferred.
• Experience training or mentoring preferred.
• Value Based contracting/payment concepts experience preferred.
• Provider education experience preferred.
• Experience presenting to various levels of leadership strongly preferred.

Job Level: Non-Management Exempt

Workshift: 1st Shift (United States of America)

Job Family: PND > Provider Relationship Account Mgmt

Elevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.