Manager - EVV and LTS Support

Presbyterian is seeking a Manager - EVV and LTS Support. This position will be responsible for the oversight of the Electronic Visit Verification (EVV) program and Long Term Services and Supports (LTSS). Requires attention to detail and strong communication skills to adequately represent the organization at conferences and speak in front of an audience. Will be responsible for the long term care team with direct supervision of staff.

 

Must possess a strong background in claims processing, managed care guidelines, New Mexico Human Services Department regulations regarding EVV and LTSS. Act as a key resource for Provider Services and provide education with an emphasis on EVV and LTSS. This position re-quires an ability to work effectively within a complex organization across multiple departments to drive results. May require some travel and the ability to work with other Managed Care Organi-zations (MCO) to create a collaborative approach to EVV and LTSS

• This is a Full Time position - Exempt: Yes
• Job is based at Rev Hugh Cooper Admin Center
• Work hours: Days 

Preferred Qualifications:

• EVV experience required
• Claims experience preferred
• LTC experience preferred
• Presentation skilled preferred
• Minimal Travel Required

• Bachelor's degree required. 6 years of additional experience can be substituted in lieu of de-gree. Previous supervisory skills required
• Experience with EVV and LTSS
• Experience with use of membership data, claims and/or encounter data
• Experience with Provider Relations/Services across multiple specialties
• Leadership skills to work across teams, drive results, and lead initiatives
• Business acumen and the ability to build credibility with all levels of the organization
• Knowledge of Healthcare benefits, terminology and concepts- especially as it relates to EVV and LTSS

• Work as part of the Provider Services staff and leadership to ensure provider partic-ipation in EVV and LTSS.
• Provide education and guidance to staff to conduct on-site visits with Providers and/or facilities to educate and inform providers and staff on EVV and LTSS
• Monitor and use information from the EVV system to verify that services provided are specified in the individual plan of care and in accordance with the established schedule, including the amount, frequency, duration and scope of each service and that services are provided by the authorized provider.
• Identify and immediately address service gaps, including late and missed visits.
• Monitor services anytime the member is receiving services including after regular business hours.
• Develop and maintain positive relationships with providers, vendors, other MCOs and the Mexico Human Services Department (HSD)
• Identify areas of opportunity for partnership between providers and PHP
• Provide oversight of vendor contracts with Provider Services and equipment needed for EVV participation and monitoring
• Create policies and procedures to support EVV and LTSS providers
• Develop and perform training (internal and external) for EVV and LTSS providers
• ensure timely completion of all required reports (internal and external)
• Execute leaderships vision of EVV and LTSS Provider Network
  
  

About Presbyterian Healthcare Services
Presbyterian offers a comprehensive benefits package to eligible employees, including medical, dental, vision, disability coverage, life insurance, and optional voluntary benefits.

The Employee Wellness Rewards Program encourages staff to engage in health-enhancing activities - like challenges, webinars, and screenings - with opportunities to earn gift to earn gift cards and other incentives.

As a mission-driven organization, Presbyterian is deeply committed to improving community health across New Mexico through initiatives like growers' markets and local partnerships. Founded in 1908, Presbyterian is a locally owned, not-for-profit healthcare system with nine hospitals, a statewide health plan, and a growing multi-specialty medical group. With nearly 14,000 employees, it is the largest private employer in the state, serving over 580,000 health plan members through Medicare Advantage, Medicaid, and Commercial plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

USD $45.82/Hr.

The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.