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 to optimize financial performance through rates and increased census, engaging in contract development and negotiation, managing relationships with contracted health plans and managed care regulatory agencies, and assessing resource utilization and cost management.

Responsibilities

• Establish, implement and evaluate strategic plans to optimize financial performance through rates and increased census.
• Engage in complex 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 effective relationships with contracted health plans and managed care regulatory agencies.
• Manage complex and high-profile health plan negotiations.
• Draft and negotiate contracts in health care operations and health care plan functional areas.
• Affirmatively analyze and coordinate amendments, reimbursement, and language changes.
• Assess resource utilization, cost management, and negotiate effectively.
• Maintain awareness of industry changes, trends, and events to proactively identify opportunities to increase market penetration and performance improvement.
• Understand 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.

Requirements

Candidate must reside in the Jacksonville, Florida area. At least 2 years of experience with Managed Care contracting is preferred. Must have a bachelor’s degree in business administration, management, or health care administration, highly desired. Knowledge of managed care contracting language, requirements, and methods to support contract compliance, contract language review, and contract analysis is essential. Knowledge of CPT-4, HCPCS, Revenue and ICD coding, and Skilled Nursing Managed care plans is required. Expertise in Skilled Nursing Managed care plans and successful operationalizing managed care contracts in the skilled nursing environment is preferred. Strong analytical skills, problem-solving abilities, and attention to detail are necessary. Excellent verbal and written communication skills, as well as critical thinking skills, are required. Computer proficiency (Contract Logix, MS Word, MS Outlook & Excel) is expected. Ability to be flexible, adaptable, and work in a rapidly changing environment is important. Present in facilities on a weekly basis, as deemed appropriate.

Qualifications

Must reside in Florida, preferably in the Jacksonville area. Willing to travel up to 80% of the time (as deemed appropriate).

Skills

• Knowledge of managed care contracting language, requirements, and methods to support contract compliance, contract language review, and contract analysis.
• Knowledge of CPT-4, HCPCS, Revenue and ICD coding.
• Expertise 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.
• Working knowledge of medical terminology, claims payment, contract negotiations, and problem resolution.
• Ability to work collaboratively in a team setting.
• 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.
• Presentation in facilities on a weekly basis, 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 as well as training sessions and seminars. For more information, visit www.ensignbenefits.com.

Pay

Compensation range depends on experience.

Schedule

This is a full-time, exempt employee position.