JOB OVERVIEW:
As part of California's Advancing and Innovating Medi-Cal (CalAIM), the state aims to move the Medi-Cal to a more consistent system through benefit standardization. Carving long-term care benefits into managed care plans (MCPs) is part of this work. The long-term care benefits cover members residing in custodial skilled nursing facilities (SNFs), Intermediate Care Facilities for the Developmentally Disabled (ICF/DD), and Subacute facilities. To support this transition, the state required all MCPs to have a Long-Term Services and Supports (LTSS) Liaison. The LTSS Liaison will serve as the primary point of contact for these facilities in both a provider representative role and to support care transitions.
PRINCIPLE RESPONSIBILITIES:
Under guidance from the Senior Director of Behavioral Health Services and LTC Operations, the LTSS Liaison is responsible for building long-term relationships with all long-term care facilities and homes in a positive and proactive manner.
Principle responsibilities include:

Serve as a single point of contact for the LTSS Provider community in both a Provider representative role and to support care transitions.
Assisting service providers in addressing claims and payment inquiries in a responsive manner.
In partnership with the Alliance's LTC Clinical Team, assist with care transitions among the LTSS Provider community to support a member's needs.
Fostering and maintaining proactive, positive relations throughout the LTSS Provider community by communicating with the facilities/homes through virtual and/or face-to-face visits, letters, telephone calls, faxes or emails for the purposes of furthering the Alliance's operational and clinical goals for the long-term care benefit as well as for gathering information and feedback from the facilities/homes about any issues or concerns related to the Alliance.
Meeting with all LTSS facilities/homes at least annually, some as frequently as quarterly, in partnership with the Alliance's LTC Clinical Team. Taking lead in such tasks as coordinating meeting dates and times, scheduling the meeting location/modality, and preparing agendas, presentations, and handouts.
Effectively identifying, directing, and/or researching provider operational issues for timely resolution per Alliance and state requirements through a thorough knowledge of all areas of Alliance operations and a strong working relationship with other departments.
Organizes and facilitates meetings between Alliance leadership and providers for training and resolving identified issues. Tracks, follows up, and accurately documents action items resulting from meetings.
Track and communicate important updates, changes, and reminders to providers.
Supports providers in new transitions and ongoing support as needed.
Helping maintain accurate contact and clinical information on all LTC facilities/homes, including maintaining an understanding of changes in ownership, correct faxes numbers, etc.
Reporting from databases and other resources to provide information about the network to internal and external customers.
Contributing to the development of written communications for the provider bulletin, manual, website and other publications and ad hoc reports and letters.
Collaborates with other Alliance departments on new initiatives and implementations to meet Alliance strategic goals with a focus on CalAIM initiatives.
Assist in the creation and maintenance of department training materials.
Perform administrative tasks as needed.
Ability to train, coach, and act as a resource to staff.
Working with teammates to complete in-house projects, mailings and special projects as assigned.
Participating in internal and external workgroups and meetings.
Performing other duties and special projects as assigned.

ESSENTIAL FUNCTIONS OF THE JOB:

Identifying and researching a variety of issues related to provider contracting, compliance and operational issues utilizing various sources including, but not limited to, current contracts, publications, websites, etc.
Reporting information in an appropriate manner either via reports, letters, or verbal communication.
Overseeing of major projects, including organization, planning, delegation of tasks and communication with provider.
Preparing and delivering verbal presentations in a group or one-on-one setting to the LTSS Provider community.
Scheduling and performing provider outreach visits, trainings, and orientation sessions to comply with Alliance and State requirements.
Frequent driving of automobiles between the worksite and LTC facilities/homes.
Performing writing, administration, analysis, and report preparation.
Problem identification and resolution.
Excellent verbal and written communication skills.
Leading and participating in internal and external committees and meetings.
Complying with the organization's Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.

PHYSICAL REQUIREMENTS:

Constant and close visual work at desk or computer.
Constant sitting and working at desk.
Constant data entry using keyboard and/or mouse.
Frequent use of telephone headset.
Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person.
Frequent lifting of folders and objects weighing between 0 and 30 lbs.
Frequent walking and standing.
Frequent driving of automobiles.

Number of Employees Direct Supervision: 0
MINIMUM QUALIFICATIONS:
EDUCATION OR TRAINING EQUIVALENT TO:

Bachelor's Degree in any field or equivalent experience preferred.

MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:

Four years job experience in provider relations for a managed care health plan or related healthcare environment preferred.
Two years of experience with government-funded managed care programs, county services and IPA/medical group administration preferred.

SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):

Excellent written and verbal communication and presentation skills and exercise sound judgment.
Strong interpersonal, organizational, analytical, and problem-solving skills.
Develop and maintain strong internal and external working relationships.
Healthcare experience working with a Medi-Cal HMO plan highly desirable.
Experience working with LTSS facilities/homes/providers highly desirable.
Knowledge of provider relations responsibilities in a managed care setting.
Customer service oriented and resourceful.
Ability to work with others while completing multiple tasks simultaneously and successfully.
Ability to make decisions in the absence of detailed instructions and work independently or in a team environment.
Knowledge of CPT, ICD-10 and HCPCS coding highly desirable.
Proficient in the use of Microsoft Office products (Word, Excel, Outlook, PowerPoint, and Access).
Valid California driver's license, auto registration, and proof of insurance required.

SALARY RANGE $105,853.04-$158,779.55 ANNUALLY
The Alliance is an equal opportunity employer and makes employment decisions on the basis of qualifications and merit. We strive to have the best qualified person in every job. Our policy prohibits unlawful discrimination based on race, color, creed, gender, religion, veteran status, marital status, registered domestic partner status, age, national origin or ancestry, physical or mental disability, medical condition, genetic characteristic, sexual orientation, gender identity or expression, or any other consideration made unlawful by federal, state, or local laws. M/F/Vets/Disabled.