Residential Services Manager - WI Based Work from Home

Description

Join our award winning culture as we support members in your area!

Position Summary:

The Residential Services Manager is responsible for establishing and managing strong partnerships with new and existing residential service providers, community agencies and community representatives to ensure an adequate and high-quality provider network exists for Lakeland Care Members. This is accomplished through development of an adequate and diverse residential provider network, establishing residential and member specific rates, ongoing evaluation of residential utilization and rate trends. The Residential Services Manager is responsible for ensuring that the Residential Services Team is supporting an environment in which Lakeland Care, Inc. (LCI) providers thrive, and develop innovative, cost-effective ways to provide services. In addition to supporting external providers, this role is essential in supporting internal stakeholders to ensure members have timely access to needed provider resources. This role is also responsible for ensuring policies are developed, followed, and modified as needed. 

The Residential Services Manager has a multi-county focus and works closely with the Provider Relations and Quality Manger, Care Management Program Managers, and the Provider Relations Senior Manager to ensure all LCI Residential Services staff communicate and practice a consistent and cohesive approach to providers and staff throughout LCI’s service regions.

Responsibilities & Competencies:

• Support the Provider Relations division by managing and providing guidance to the Residential Services Supervisor, Residential Development Specialist, and the Provider Relations Assistant.  
• Demonstrate understanding of Service Provider Contracting, regulatory requirements for residential settings, the DHS Family Care Contract, Service Rates, and ramifications of decisions.
• Maintain awareness of organizational interests and ensure that Service Provider Contracts include required elements and support LCI’s needs.
• Provide education and support regarding the Family Care program, regulatory requirements, and industry trends.
• Coordinate activities with network and non-network providers to ensure availability of appropriate services. Ensure that natural community resources are available within the network.
• Strong interdivisional collaboration and communication including Quality and Care Management divisions related to needs of members, interpretation of data, and action steps required.
• Use cost and utilization data to drive decision making. Develop and analyze proactive indicators to address changing and emerging needs of members.
• Review, monitor, and develop sustainable Rate Methodologies for residential services.
• Work towards continuous improvement by evaluating systems, giving honest and timely feedback, and being open to supporting organizational change.
• Ability to organize, facilitate, and contribute to LCI stakeholder and provider meetings/forums, and represent LCI at professional events (internal and external.)
• Respond constructively to demanding situations, make high impact decisions, and appropriately resolve conflict.
• Influence others through positive reinforcement, teamwork, and content knowledge.
• Motivate and lead a high-performing team; attract, recruit, and retain employees while providing mentoring and professional development.

Requirements

• Bachelor’s degree in Accounting, Business, Social Work, Healthcare Administration, other related field, or equivalent combination of education and experience (includes knowledge, skills, and abilities). 
• Minimum of six (6) years leadership experience in the health care, long-term care, or health insurance industry. Two (2) to four (4) years of experience in contract negotiation supporting purchaser-provider business relationships, preferably in long-term care or acute and primary health care.
• Analytical skills in health care financial and utilization data.
• Knowledge of the service provider industry, subcontracting, and licensing and regulatory systems; and knowledge of provider network contracting in a managed care model preferred.
• Knowledge of federal and state rules and regulations of Medicaid/Medicaid waiver programs. 
• Demonstrated knowledge of managed care principles.
• Demonstrated ability to read, analyze, and interpret business documents and advanced professional communications.  
• Ability to work within time constraints and maintain attention to detail.
• Ability to respond effectively to sensitive inquiries and situations.  
• Demonstrated ability to communicate with diverse segments of the general population and professional community.