LTSS Network Relations Consultant, West Iowa

Anticipated End Date:

2025-12-03

Position Title:

LTSS Network Relations Consultant, West Iowa

Job Description:

LTSS Network Relations Consultant, West Iowa
Location: Carroll, Iowa and surrounding counties

Hours: Standard M - F

Field: This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Please note: This position will cover the West region of Iowa, residency in Iowa is a requirement and the ability to travel within the west region.

The LTSS Network Relations Consultant, West Iowa develops and maintains positive provider relationships with provider community by regular on-site visits, communicating administrative and programmatic changes, and facilitating, education and the resolution of provider issues.

Serving as a knowledge and resource expert regarding provider issues impacting provider satisfaction, researches and resolves complex provider issues and appeals for prompt resolution. May be responsible for coordinating non-negotiated contracts for new and existing providers as needed.

How you will make an impact:

• Researches, analyzes and recommends resolution for contract dispute, non-routine claim issues, billing questions and other practices.
• May participation in Joint Operation Committees (JOC) of larger provider groups.
• Coordinates communication process on such issues as administrative and medical policy, reimbursement and provider utilization patterns.
• Conducts seminars to support the understanding of managed care policies and procedures.
• Identifies network access and deficiencies and develops recruitment and contracting strategies.
• Coordinates and conducts provider training including developing and distributing provider relations materials. Responsible for providing quality, accessible and comprehensive service to the company's provider community.
• Provide assistance regarding education, contract questions and non-routine claim issues.
• Coordinates communications process on such issues as administrative and medical policy, reimbursement and provider utilization patterns.
• Coordinates prompt claims resolution through direct contact with providers, claims, pricing and medical management department.
• Identifies and reports on provider utilization patterns which have a direct impact on the quality of service delivery.
• Tracks and conduct provider refresher training.
• Researches issues that may impact future provider negotiations or jeopardize network retention. 

Minimum Requirements:

• Requires a Bachelor's degree and a minimum of 3 years of customer service experience including 2 years experience as a Network Management Rep; or any combination of education and experience, which would provide an equivalent background. 
• Travels to worksite and other locations as necessary.

Preferred Skills, Capabilities and Experiences:

• Experience working with LTSS and or Waiver populations preferred
• Experience presenting to leadership and varied audiences preferred
• Training background preferred
• Interpersonal Skills is a must
• Ability to operate independently strongly preferred

Job Level:

Non-Management Exempt

Workshift:

Job Family:

PND > Provider Relationship Account Mgmt

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our busine