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 preparation for changes in the healthcare industry.

Job Duties and Responsibilities

• Establish, implement and evaluate the strategic plan(s) that will ensure each local operation the ability to optimize financial performance through rates and increased census.
• Engage in complex levels of contract development and negotiation, including risk agreements using utilization, claims and market data with health plans and direct service agreements with physicians, physician organizations and hospitals and ancillary providers.
• Identify, develop and maintain an effective relationship with contracted health plans and managed care regulatory agencies.
• Manage complex and high-profile health plan negotiations.
• Actively draft and negotiate contracts in the health care operations and health care plan functional areas.
• Affiliate in analysis and coordination of amendments, reimbursement, and language changes.
• Assess resource utilization, cost management and negotiate effectively.
• Maintain monitoring of industry changes, trends and events to proactively identify opportunities to increase market penetration and performance improvement.
• Understand the competitive pricing levels in the local market and improve the company's cost position through unit costs strategies.
• Strategize for facility census growth and retention.
• Teach, Train and Instruct facility level personnel on how to operationalize the contract.
• Interact with facility personnel on utilization, clinical results and managed care census.

Preferred Qualifications

• 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 Florida, preferably in the Jacksonville area.
• Willing to travel up to 80% of the time (as deemed appropriate).
• Knowledge of managed care contracting language, requirements, and methods to support the development and maintenance of contract compliance, contract language review and contract analysis.
• Knowledge of CPT-4, HCPCS, Revenue and ICD coding.
• Expert in Skilled Nursing Managed care plans.
• Experience in successful operationalizing managed care contracts in the skilled nursing environment.
• Knowledge of contracts and contractual interpretations for payment and benefit issues.
• Work with a working knowledge of medical terminology, claims payment, contract negotiations, and problem resolution; ability to work collaboratively in a team setting.
• Communicate effectively at all organizational levels and in situations requiring instructing, persuading, negotiating, consulting, and advising.
• Have a strong analytical mind, with problem solving skills, an aptitude for accuracy, and attention to detail.
• Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously.
• Have excellent verbal and written communication skills, as well as excellent critical thinking skills.
• Be computer savvy (Contract Logix, MS Word, MS Outlook & Excel).
• Be flexible, be readily adaptable, and work in a rapidly and constantly changing environment.
• Present in facilities on a weekly basis, (currently as deemed appropriate).

Additional Information

Pre-employment criminal background screening required.

What We Offer

We are committed to providing 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.