LTSS Provider Network Operations Analyst II- MUST RESIDE IN THE STATE OF OHIO!

CareSource Management Services LLC • Dayton, OH • 6h ago

Job Summary:
The Provider Network Operations Analyst II executes small to medium scale project plans, business and data analysis, and provides specialized support of the LTSS & HCBS provider network and EVV compliance initiatives.
Essential Functions:
Analyze data, workloads, and processes to enhance operations efficiencies in support of LTSS & HCBS providers.
Identify trends and solutions to operational support and ensure provider adherence to regulatory and contractual requirements.
Perform quality assurance reviews to ensure that provider information is loaded correctly, and contracting terms are accurately operationalized.
Assist with research and resolution of provider inquiries and provide a professional and comprehensive response to providers and other stakeholders as required.
Improve Electronic Visit Verification compliance rates for provider network
Perform virtual initial onboarding and ongoing education to provider network.
Manage online communications and optimize service delivery and provider experience.
Assist with network adequacy requirements through analysis and service delivery resulting in provider retention.
Responsible for understanding regulations changes and monitoring LTSS and HCBS provider network for compliance.
Partner with leadership within business area to prioritize opportunities to achieve department and organizational goals.
Support LTSS updates via network notifications, virtual townhalls, and direct interactions
Recognize and proactively identify operational dependencies and process improvements
Develop and maintain dashboard reporting for leadership
Produce detailed reports and business decision documents
Develop and maintain an in-depth knowledge of the company's business and regulatory environments
Perform any other job-related instructions, as requested
Education and Experience:
Bachelor of Science/Arts degree or equivalent years of relevant work experience is required
Minimum of three (2) years of business management or health care operations experience in insurance, managed care, or related industry is required
Minimum of two (2) years Provider Relations experience is required.
Advanced knowledge of Medicaid, Medicare, MyCare, LTSS, HCBS, and Ohio Home Care Waiver is required.
Minimum of two (2) years of experience in leading business initiatives to drive systemic change is preferred
Competencies, Knowledge and Skills:
Proficient in Microsoft Office Suite to include Word, Excel and PowerPoint
Proficient in data analysis
Effective identification of business problems, assessment of proposed solutions to those problems, and understanding of the needs of business partners
Proven experience with project management tools and resolution of open issues
Ability to execute small to medium scope project plans including business requirements gathering, definition/prioritization, project scope definition, training, and documentation,
Comprehensive knowledge of project methodology, scheduling, and forecasting skills
Excellent written and verbal communication and interaction skills
Knowledge of regulatory reporting and compliance requirements
Effective problem-solving skills with attention to detail
Ability to develop, prioritize and accomplish goals
Licensure and Certification:
Employment in this position is conditional pending successful clearance of a driver's license record check. If the driver's license record results are unacceptable, the offer will be withdrawn or, if you have started employment in this position, your employment in this position will be terminated
To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October

Similar Jobs

Hallmark Field Territory and Installation Supervisor (part-time) - Vandalia, OH

Hallmark Marketing Company LLC • Dayton, OH • 1h ago

Description To learn more about this role, watch our Supervisors in action. JOB OVERVIEW The Field Territory and Installation Supervisor (TIS) is a part-time position responsible for supervising a group of Field and Inst...

1h ago

Go to Apply

Care Manager, LTSS

Molina Healthcare • Dayton, OH • 3h ago

Management & Administrative

JOB DESCRIPTION Job Summary Provides support for care management/care coordination long-term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of memb...

3h ago

Go to Apply

Care Manager, LTSS

Molina Healthcare • Dayton, OH • 3h ago

Management & Administrative

3h ago

Go to Apply

Assistant Store Leader (Assistant Manager)

7-Eleven • Centerville, OH • 5h ago

Retail & Hospitality

Assistant Store Leader (Assistant Manager) Apply Now ( https://olivia.paradox.ai/co/7Eleven60/Job?job\id=PAF-7E-04B5EC5D-5BAC-4F1E-A2FE-3453F1FA0AF0\2132\1735340560\0 ) Save Job Job ID EASL45619 Store-ID 45619 Address 54...

5h ago

Go to Apply

Maintenance Certified Master Technician

BUD ANTLE, INC. • Springfield, OH • 6h ago

Retail & Hospitality

Maintenance Certified Master Technician LinkedIn Twitter Email Message Share Category Maintenance All Locations 600 Benjamin Dr., Springfield, Ohio Position Type Full-Time/Regular Tracking Code 034 GENERAL DESCRIPTION /...

6h ago

Go to Apply

Wright State University Nutter Center - Event Security

Allied Universal • Cedarville, OH • 6h ago

Sales & Marketing

Company Overview: Kick off your exciting career in Event Security with Allied Universal® Event Services, the go-to leader in crowd management and event staffing. Dive into the action at sports stadiums, concerts, festiva...

6h ago

Go to Apply

Part Time Freight Handler

GORDON FOOD SERVICE INC • Springfield, OH • 7h ago

Welcome to Gordon Food Service! We are excited that you are thinking about opportunities with us, and we have an amazing story to share. See below for a quick glance of who we are and the impact you could have on the foo...

7h ago

Go to Apply

Area Manager

Performance Food Group • Dayton, OH • 9h ago

Management & Administrative

131905BR Job Title: Area Manager Location: Performance Foodservice Cincinnati (0572) Job Description: We Deliver the Goods: Competitive pay and benefits, including Day 1 Health & Wellness Benefits, Employee Stock Pur...

9h ago

Go to Apply

Bilingual (Spanish) - Accounting Administrator - Springfield, OH

Konecranes • Springfield, OH • 9h ago

Retail & Hospitality

Springfield, OH, United States Employment Type: Permanent Term Full-time/part-time position: Full-time Workplace: Field Service Company Description At Konecranes, we believe that great customer experience is built on the...

9h ago

Go to Apply

Representative, CC Member Advocate

Molina Healthcare • Dayton, OH • 9h ago

Job Description Job Summary Makes outbound calls to members, completes assigned hand-dial lists, and provides proactive member support, information, and assistance. Adheres to member interaction departmental standards, c...

9h ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.