Managed Care Contracting Liaison

Fort Worth, Texas

About the Role

We’re seeking an experienced and relationship-focused Managed Care Contracting Liaison to join our team and serve as a key connection between our skilled nursing facilities (SNFs) and managed care organizations, Medicare Advantage plans, and Texas Medicaid managed care programs, including STAR+PLUS. This position plays a vital role in supporting contract negotiations, rate management, network participation, authorizations, and payer relationships across an assigned portfolio of Texas SNFs.

Responsibilities

• Support Contract Negotiations: Assist with the negotiation, renewal, and amendment of managed care and Medicare Advantage contracts, including rate schedules, per diem structures, case rates, and value-based or risk arrangements.
• Analyze Contract Terms: Evaluate proposed contract terms using facility cost data, payer mix, and market benchmarks, and provide recommendations to leadership regarding acceptable rates and terms.
• Manage Contract Data: Maintain an accurate contract matrix tracking effective dates, rate terms, renewal deadlines, termination clauses, and other key contract details.
• Build Payer Relationships: Serve as a primary liaison with MCO network development, provider relations, and utilization management representatives, including Texas STAR+PLUS MCOs and Medicare Advantage plans.
• Strengthen Network Partnerships: Develop and maintain payer relationships that support timely admissions, authorizations, issue resolution, and effective communication.
• Coordinate Payer Meetings: Partner with key payers to review performance, denial trends, contract compliance, and opportunities for improvement.
• Resolve Authorization Issues: Work closely with facility admissions, case management, and business office teams to address authorization delays, level-of-care disputes, and concurrent review issues.
• Support Denials Management: Track and analyze denial patterns and payer scorecards, escalating systemic concerns through appropriate contracting channels.
• Navigate Medicaid Requirements: Assist facilities with Texas Medicaid managed care prior authorization and utilization review requirements.
• Maintain Regulatory Knowledge: Stay current on Texas HHSC Medicaid managed care requirements, STAR+PLUS program rules, and CMS Medicare Advantage regulations affecting SNF network participation and reimbursement.
• Support Compliance: Help ensure contract terms align with applicable Texas Medicaid managed care requirements and CMS network adequacy standards.
• Partner with Legal and Compliance: Coordinate contract language reviews and support the organization in responding to regulatory and payer-related changes.
• Prepare Reports: Develop reports on contract status, rate comparisons, payer mix trends, and network participation for facility administrators and corporate leadership.
• Monitor Reimbursement: Compare reimbursement rates against Medicaid fee-for-service benchmarks and regional market rates.
• Support Budgeting: Provide payer mix, contract rate, and reimbursement data to support annual budgeting and rate-setting processes.
• Coordinate Across Facilities: Manage multiple priorities and maintain effective communication across an assigned portfolio of skilled nursing facilities.

Requirements

• Current Texas LVN or RN license in good standing with the Texas Board of Nursing.
• 3+ years of experience in managed care contracting, payer relations, or healthcare reimbursement, preferably within long-term care or skilled nursing.
• Working knowledge of Texas Medicaid managed care programs, including STAR+PLUS and applicable Texas HHSC contracting requirements.
• Experience working directly with Texas Medicaid MCOs and/or Medicare Advantage plans.
• Understanding of Medicare Advantage network participation and skilled nursing reimbursement methodologies.
• Experience reviewing and negotiating payer contract language, rate exhibits, and amendments.
• Prior experience contracting specifically for skilled nursing or long-term care networks with Texas MCOs.
• Experience with denials management and utilization review escalation processes.
• Established relationships with Texas MCO network development or provider relations teams.
• Strong analytical abilities with proficiency in Excel; experience with contract management or reimbursement software is a plus.
• Excellent relationship-management, negotiation, written, and verbal communication skills.
• Strong ability to identify issues, develop solutions, and manage appropriate escalation.
• Ability to coordinate multiple facilities, priorities, contracts, and payer relationships effectively.
• Ability to travel as needed to skilled nursing facilities across an assigned Texas region.

Working Environment

• Collaborative Leadership: Work closely with facility administrators, corporate leadership, reimbursement teams, admissions, case management, business office staff, compliance, and legal teams.
• Payer Engagement: Regular interaction with managed care organizations, Medicare Advantage plans, and other payer representatives.
• Regional Travel: Travel may be required to SNFs, payer meetings, conferences, and other business locations throughout Texas.
• Flexible Meetings: Participation in virtual or in-person meetings outside normal business hours may occasionally be required based on payer or organizational needs.
• Independent Work: Manage multiple priorities and work independently with minimal supervision while maintaining strong communication and follow-through.

Benefits

• Comprehensive Coverage: Health, Dental, and Vision Insurance
• Extra Protection: AD&D, Short-Term Disability, Cardiac, Cancer, Critical Illness, Hospital Confinement
• Life Insurance: Whole and Term Policies
• Professional Growth: Tuition Reimbursement for continued education
• Time to Recharge: Paid Time Off
• Retirement Planning: Immediate 401(k) eligibility
• Unwavering Support: Exceptional corporate resources