Managed Care Resource

About the role

The Managed Care Consultant supports Skilled Nursing Facility leaders in managed care contracting and revenue enhancement strategies for all healthcare payers and prepares for changes in the healthcare industry. Key responsibilities include establishing strategic plans, engaging in contract development and negotiation, managing relationships with health plans, and assisting with contract amendments.

Responsibilities

• Establish, implement and evaluate strategic plans to optimize financial performance through rates and increased census.
• Develop and maintain effective relationships with contracted health plans and managed care regulatory agencies.
• Negotiate contracts for new locations, assist with contract updates, and help with cancellations, denials, and appeals.
• Assess resource utilization, cost management, and negotiate effectively.
• Maintain awareness of industry changes, trends, and events to proactively identify opportunities for market penetration and performance improvement.
• Strategize for census growth and retention.
• Teach, train, and instruct facility-level personnel on operationalizing contracts.
• Interact with facility personnel on utilization, clinical results, and managed care census.

Requirements

• A bachelor’s degree in business administration, management, or health care administration, highly desired.
• At least 2 years of experience with Managed Care contracting, highly desired.
• Must reside in Georgia, preferably in the Atlanta area.
• Willing to travel up to 80% of the time (as deemed appropriate).

Preferred Qualifications

• Knowledge of managed care contracting language, requirements, and methods to support contract compliance.
• Knowledge of CPT-4, HCPCS, Revenue and ICD coding.
• Expertise in Skilled Nursing Managed care plans.
• Experience in successfully operationalizing managed care contracts in the skilled nursing environment.
• Knowledge of contracts and contractual interpretations for payment and benefit issues.
• Strong analytical mind, with problem-solving skills, an aptitude for accuracy, and attention to detail.
• Excellent verbal and written communication skills, as well as excellent critical thinking skills.
• Computer savvy (Contract Logix, MS Word, MS Outlook & Excel).
• Ability to be flexible, adaptable, and work in a rapidly changing environment.
• Present in facilities on a weekly basis, (currently as deemed appropriate).

Benefits

We offer a competitive benefits and compensation package which includes medical/dental/vision coverage, company-provided life insurance, 401(k) with company match, and sick/vacation plans. We also support professional growth and development through our Learning Management System and training sessions and seminars. Learn more about our benefits at www.ensignbenefits.com.

Equal Opportunity Employer

Ensign Services, Inc. is an equal opportunity employer. If you need assistance or accommodation during the application process, please contact us at 888-659-3616.