Managed Care Resource - Southeast Region
About the Company
Our growing company serves over 378 health care operations that employ over 55,000 employees across 17 states. These operations have no corporate headquarters or traditional management hierarchy. Instead, they operate independently with support from the Service Center" - a team of accounting, legal, human resources, benefits, compliance, payroll, construction, training, and information technology resources. Service Center human resources employees are dedicated subject matter consultants who guide and advise field personnel. This structure allows on-site leaders and caregivers to focus on day-to-day issues in their individual operations.
What sets ESI apart from other companies is the quality of our most valuable resource - our people.
About the Opportunity
The Managed Care Consultant supports the Skilled Nursing Facility leaders in managed care contracting and revenue enhancement strategies for all healthcare payers and preparation for changes in the healthcare industry. The Consultant will provide guidance regarding development of managed care relationships and rate negotiation, ensuring timeliness and rate appropriateness. Additionally, the Consultant will negotiate contracts for new locations, assist with ensuring that contracts are updated for new services, and help with contract cancellations, denials, and appeals.
Essential Functions and Responsibilities
Establish implement and evaluate the strategic plans 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. Assist 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. Understands the competitive pricing levels in the local market and improves the companys cost position through unit costs strategies. Strategizes 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.
Qualifications
Knowledge of managed care contracting, language requirements, and methods to support the development and maintenance of contract compliance, contract language review, and contract analysis. Must be knowledgeable about the managed care environment, including capitation, PPO, HMO, IPA, ACO, and POS. 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. 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. Ability to deal with responsibility and confidentiality with matters. Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA). Strong analytical mind with problem-solving skills, an aptitude for accuracy, and attention to detail. Must be able to prioritize plans and handle multiple tasks and demands simultaneously. Excellent verbal and written communication skills, as well as excellent critical thinking skills. Computer savvy with Contract Logix, MS Word, MS Outlook, and Excel. Ability to 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.
Desired Qualifications
Must reside in Jacksonville, FL. Preference for a bachelors degree in business administration, management, or health care administration. Willing to travel up to 80% of the time as deemed appropriate. Highly desire at least 2 years of experience with Managed Care contracting. Additional Information
Wage Rate
Depending on Experience
Position Type
Full-time exempt employee
Location
Candidate must reside in the Jacksonville, FL area.
What We Offer
We are committed to providing a competitive benefits and compensation package, which includes medical, dental, vision coverage, company-provided life insurance, 401k with company match, and sick/vacation plans. We also believe in supporting our employees professional growth and development through our Learning Management System, as well as training sessions and seminars. Take a look at these benefits and more at www.ensignbenefits.com.
Ensign Services Inc. is an Equal Opportunity Employer.
Pre-employment criminal background screening required.