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

About the position 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. Network Relations Consultant Senior (Value-Based Program Specialist) – MyCare Ohio Location: This position is based in Ohio; the associate will report to one of our 4 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. 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.

Responsibilities

• 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 stake holders 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.

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.

Nice-to-haves

• 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.

Benefits

• In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

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