Representative, Health Plan Provider Relations ( Wisconsin long-term services and supports (LTSS) Provider Quality; must reside in Wisconsin)

Job description

JOB DESCRIPTION Job Summary Position collaborates daily with LTSS providers to include Adult Family Homes, Assisted Livings, Adult Day Care Centers, Ancillary Providers, and Nursing Homes in review of potential concerns in quality-of-service delivery to MCW members. Ensures provider quality for My Choice Wisconsin programs; compliance with contracts and certifications; investigates provider quality concerns; mitigates risk; subject matter expert on provider policies and procedures. The position performs all tasks associated with the provider concern process for the department to include concern review, review as applicable to quality standards and contract compliance, maintenance of concerns, provider corrective action plans, timely and accurate responses and onsite provider visits when severe concerns are identified. Essential Job Duties: - Direct involvement and working knowledge of Wisconsin Long Term Care/Residential Care regulations, residential quality, deep understanding of Regulatory/oversight entities in Wisconsin to include but not limited to DQA, DHS, APS, Ombudsman or related experience - Ability to maintain schedules, meet deadlines, and differentiate urgent work and a...