Long Term Support Services (LTSS) Liaison

To Act as a Long Term Services and Supports (LTSS) Provider Liaison-Long Term CareFacilities and Skilled Nursing Facilities (SNF) including the responsibility of collaborating withinternal departments to identify process improvement and maintaining consistent knowledge ofbenefit changes from the Department of Health Care Services.

Responsibilities

Assists providers and facilities with transitions of care to support the member’s needs. Serves as a point of contact for LTSS providers at the health plan to address questions forpayment, claims and/or Partnership contract language. Coordinates with clinical staff within Health Services to address authorization, carecoordination, and/or transitional care needs for Partnership members. Maintains benefit standardization and surface issues or questions to the appropriate stafffor process improvement. Provides education to providers regarding availability of community resources and howto access these resources. Identifies learning opportunities for hospitals, providers and/or topics for communitypartners. Progresses new strategic partnerships with key stakeholders and identifies opportunitiesto expand outreach and educational efforts Collaborates with Partnership’s Qualitydepartment to support new and ongoing quality programs that impact LTSS providerssuch as the Quality Assurance and Performance Improvement (QAPI). Works in conjunction with internal counterparts to proactively support networkperformance and process improvement. Develops structures, relationships, and processes to promote active partnerships withproviders, community stakeholders, and/or other healthcare professionals to meet andsupport key organizational initiatives (ex: county partners, hospitals, DME vendors,skilled facilities, CBAS centers, ECM/CS providers, etc.) Stays informed of changes related to benefits, regulations and/or Partnership policiesrelated to LTSS services. Receives training on the full spectrum of rules, regulations, policies and procedurespertaining to Medi-Cal covered Long Term Care (LTC), including:

Payment and coverage

Prompt claims payment requirements

Provider resolution

Care management

Care coordination

Transition of care

Disseminates their contact information to relevant LTSS, SNF and LTC NetworkProviders. Other duties as assigned.

Qualifications

Education and Experience

Bachelor’s degree in Business Administration, Business Management,Computer Science or relevant field and at least one (1) year of relevantprogram management experience required. In lieu of degree, aminimum of three (3) years of relevant experience to include aminimum of two (2) years program management experience will beconsidered.

Special Skills, Licenses and Certifications

Critical thinking, strong organization skills with ability to prioritizeassignments and manage time effectively. Effective communicationskills, both verbal and written, to interpret and articulate programrequirements to involved stakeholders. Excellent attention to detail.Working knowledge of project/program management methodologiesrequired. Valid California driver’s license and proof of currentautomobile insurance compliant with Partnership policy are required tooperate a vehicle and travel for company business.

Performance Based Competencies

Knowledge of business practices and protocols with ability to accessdata and information using automated systems. Ability to participate inteam based projects. Strong organizational skills with ability toprioritize assignments and maintain effective filing systems and meetdeadlines. Strong attention to detail; critical thinking/listening andcommunication skills.

Work Environment And Physical Demands

More than 50% of work time is spent using a computer. Ability to lift,carry, or move objects of varying size, weighting up to 25 lbs. Must beable to work in a fast-paced environment and maintain courtesy andcomposure when dealing with internal and external customers. Abilityto function effectively with frequent interruptions and direction frommultiple team members.

All HealthPlan employees are expected to:

Provide the highest possible level of service to clients;

Promote teamwork and cooperative effort among employees;

Maintain safe practices; and

Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

HIRING RANGE:

$85,173.51 - $106,466.89

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

Regular Full-Time