Managed Care Provider Relations Manager jobs in Conway, AR

POSITION SUMMARY:

Develops, implements, and monitors the person-centered Total Plan of Care (TPOC) for assigned members with behavioral health needs, developmental/intellectual disabilities, and/or substance use disorders, and other special populations; works closely with members, their families/guardians, their providers, and other members of their circle of support, to ensure the member is receiving the most appropriate care while addressing barriers to access to healthcare.

ESSENTIAL JOB FUNCTIONS:

1. Develops, documents, evaluates, monitors, and modifies the assigned members’ person-centered Total Plan of Care (TPOC) on an ongoing basis, including member choices; the care plan may include, but is not limited to, the following areas of service: Behavioral Health, Community Resources, Crisis Safety, IDD/Waiver, Financial Information, Mental Health, Physical Health, and Substance Abuse.

2. Ensures that members’ health, safety, and service needs are met by working directly with the individual members, their families/guardians, their providers, and other members of their circle of support.

1. Maintains contact to discuss care plans with members, families/guardians, providers, community resources, stakeholders, and other professionals; visits in person, by telephone, and virtually, utilizing a company-provided laptop with communication and database software applications.

1. Documents work activities and member information into the electronic medical records system (EMR) in a timely manner according to APC policies regarding documentation.

1. Develops and maintains electronic records within the databases utilized in the organization, including EMR.

1. Answers questions and provides information over the telephone, email, and in person; answers and assists callers via telephone calls, utilizing a company-provided cellular telephone.

1. Coordinates and schedules appointments, meetings, and travel, for self; manages one’s own electronic calendar utilizing Microsoft Outlook.

1. Maintains confidentiality of member personal and medical information; limits such information on a strict “need-to-know” basis.

1. Promotes individual and organizational continuous learning and performance improvement by modeling own self-directed professional development and remaining current on methods, tools, and resources needed to improve job performance; demonstrates that new learning gained from professional development is incorporated into practice.

1. Maintains the confidentiality and integrity of Arkansas Provider Coalition at all times, complying with The Health Insurance Portability and Accountability Act (HIPAA) and Arkansas Provider Coalition policies.

1. Maintains compliance with Conflict-Free Case Management rules, as well as all applicable rules and regulations within the Arkansas PASSE Medicaid Provider Manual, Section II, 240.000, the Arkansas PASSE Care Coordination Agreement, Arkansas Insurance Department, Arkansas Medicaid, and other applicable Medicaid Manuals and updates.

1. Operates a company-issued laptop computer with Microsoft Office/Microsoft 365 suite products, Microsoft Teams, and other communication and database software in the performance of essential job functions.

1. Operates a personal automobile in the performance of essential job functions for travel to meetings, members’ homes, provider offices, conferences, and training.

SECONDARY DUTIES AND RESPONSIBILITIES:

1. Performs other related duties as assigned.