Managed Care Resource

About the role

Ensign Services, Inc. (“ESI”) is a subsidiary of The Ensign Group, Inc., a leader in the post-acute care industry. ESI provides support services to over 378 facilities employing over 55,000 employees.

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.
• Aid in analysis and coordination of amendments, reimbursement, and language changes.
• Assess resource utilization, cost management, and negotiate effectively.
• Monitor 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 operationalizing contracts.
• Interact with facility personnel on utilization, clinical results, and managed care census.

Requirements

• Bachelor’s degree in business administration, management, or health care administration, highly desired.
• At least 2 years of experience with Managed Care contracting in a Senior Living/Skilled Nursing or Long-Term Care community, highly desired.
• Willingness to travel up to 80% of the time (as deemed appropriate).
• Knowledge of managed care contracting language, requirements, and methods to support contract compliance, contract language review, and contract analysis.
• Knowledge of capitation, PPO, HMO, IPA, ACO, and POS.
• 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, problem-solving skills, accuracy, and attention to detail.
• Ability to prioritize, plan, and handle multiple tasks/demands simultaneously.
• Excellent verbal and written communication skills, as well as critical thinking skills.
• Computer savvy (Contract Logix, MS Word, MS Outlook & Excel).
• Flexibility, adaptability, and ability to work in a rapidly changing environment.
• Present in facilities on a weekly basis, as deemed appropriate.

Qualifications

• Pre-employment criminal background screening required.

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.

Schedule

Present in facilities on a weekly basis, as deemed appropriate.

Pay

$78,497 per year