Director of Managed Care
About the role
Directs and performs contract negotiations with managed care payers including rates and terms.
Analyzes existing managed care agreements to determine if rates need to be renegotiated, or if contract needs to be terminated.
Provides consultation with operations to determine desired next steps.
Maintains database of managed care agreements and SNF access.
Supports and educates regional operation teams and SNFs on all new contracts, contract changes and contract clarification of terms.
Develops and analyzes payer contract activity when requested by SNF or identified as a concern.
Reviews managed care PPD trends identified and communicates findings with Regional Ops and SNF operator.
Reviews/Analyzes P&L and/or participates in Ops calls/mtgs to determine if SNF capturing managed care exclusions.
Coordinates communications between managed care payer and clinical, case management, admissions, business development and business offices at SNFs.
Maintains database of agreements.
Completes initial managed care payer agreements credentialing in conjunction with MNS.
Coordinates with Legal Department VA/SAM registrations.
Manages, assesses SNF Hospice Agreements and recommends rates, etc.
Maintains database of agreements.
Manages and establishes VA Agreements for SNFs, including VA contract extensions.
Analyzes Level of Care rate percentages with SNF operator before finalizing agreement.
Responsibilities
- Directs and performs contract negotiations with managed care payers including rates and terms.
- Analyzes existing managed care agreements to determine if rates need to be renegotiated, or if contract needs to be terminated.
- Provides consultation with operations to determine desired next steps.
- Maintains database of managed care agreements and SNF access.
- Supports and educates regional operation teams and SNFs on all new contracts, contract changes and contract clarification of terms.
- Develops and analyzes payer contract activity when requested by SNF or identified as a concern.
- Reviews managed care PPD trends identified and communicates findings with Regional Ops and SNF operator.
- Reviews/Analyzes P&L and/or participates in Ops calls/mtgs to determine if SNF capturing managed care exclusions.
- Coordinates communications between managed care payer and clinical, case management, admissions, business development and business offices at SNFs.
- Maintains database of agreements.
- Completes initial managed care payer agreements credentialing in conjunction with MNS.
- Coordinates with Legal Department VA/SAM registrations.
- Manages, assesses SNF Hospice Agreements and recommends rates, etc.
- Maintains database of agreements.
- Manages and establishes VA Agreements for SNFs, including VA contract extensions.
- Analyzes Level of Care rate percentages with SNF operator before finalizing agreement.
Requirements
Bachelor’s Degree in business or healthcare related field with minimum 5 years of healthcare experience and 3 years of managed care experience.
Self-motivated and has the ability to manage and prioritize projects.
High degree of accuracy and mental awareness.
Ability to make accurate independent decisions, influence change without direct authority using good negotiation skills.
Familiar with SNF operations, practices and procedures.
Current knowledge of managed care in multiple states and ability to model agreements with services and capabilities offered at the SNFs.
Current understanding of healthcare issues, trends, business development opportunities.
Working knowledge of state and federal law, rules and regulations which apply to government, commercial, Workers Compensation and VA reimbursement for SNFs.
Qualifications
Education and/or Experience:
- Bachelor’s Degree in business or healthcare related field.
- Minimum 5 years of healthcare experience.
- Minimum 3 years of managed care experience.
Skills
- Contract Negotiations
- Managed Care Contract Analysis
- SNF Operations Support
- Contract Management
- Communication Coordination
- Financial Strategy Development
- Legal Compliance
- VA/Commercial Reimbursement Knowledge
Benefits
$110,000 - $150,000 annually depending on experience.
PACS is an equal opportunity employer.
We celebrate diversity and are committed to creating an inclusive environment for all employees.
We welcome applicants of every race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, and any other protected characteristic.
Join PACS: Elevate Healthcare with Us!
At PACS, we believe our employees are our greatest asset. That’s why we offer an exceptional benefits package designed to enhance your well-being and support your lifestyle.
Our Comprehensive Benefits Include:
- Health Coverage: Medical, Dental, Vision Plans.
- PTO and Vacation: Generous Paid Time Off and Holidays.
- Financial Wellness: Health Savings Accounts (HSA), Flexible Spending Accounts (FSA).
- Retailer Planning: 401(k) Plan with Company Contributions.
- Support When You Need It: Employee Assistance Plan (EAP).
Join us at PACS and take advantage of a workplace that truly values you!