Director of Managed Care

General Purpose This position manages, negotiates, and optimizes reimbursement agreements between SNFs and managed care organizations. The Director of Managed Care will be responsible for maintaining relationships with existing managed care plans, identify new managed care payers in states/markets served, and providing education to our SNFs on how to operationalize contracts.

Essential Duties Negotiate new managed care agreements with health plans, the VA and hospitals. Negotiations include but are not limited to exclusions, add-ons, levels of care, lines of business and terms.

Evaluate contracts for financial viability against operational costs.

Lead initiatives to increase Managed Care PPD and expand health plan contract networks.

Identify and secure relationships with new health plans and specialized service lines.

Analyzes existing managed care agreements to determine if rates need to be renegotiated, or if contract is still viable. Consult with Administrator/Regional Vice President to determine desired next steps.

Primary liaison between the health plans and the SNF team plus any supporting internal departments.

Track SNF metric compliance required by health plans. Monitor the data to ensure they are meeting the health plan contracting requirements for ALOS, RTA, clinical outcomes, star ratings or other plan requirements.

Maintains database of managed care agreements and SNF access.

Educate Admissions, Marketing, Case Management, Billing, and Administrators to ensure a smooth contract implementation and accurate reimbursement.

Partner with AR to resolve high dollar managed care reimbursement issues when escalation attempts have been unsuccessful.

Reviews managed care PPD trends and collaborates with Regional Operations and Administrators on best ways to operationalize contracts.

Participates in Operations, Health Plan and Team meetings virtually and in-person.

Partners with Managed Care Credentialing and additional internal PACS Departments as needed to maintain documents required for contracts.

Collaborates with the PACS Legal Department to review contract language, as needed.

Ensure all contracts comply with internal and external mandates and/or regulations.

Qualification

- Education and Experience Bachelor’s Degree in business or a healthcare related field with a minimum of 8 years of healthcare contracting experience, preferably within skilled nursing.

Self-motivated and has the ability to manage and prioritize projects.

Acute perception and ability to multi-task with high degree of accuracy.

Ability to make independent decisions and influence change without direct authority.

Familiarity of SNF Operations is highly preferred.

Profound understanding of SNF reimbursement methodologies (PDPM, levels of care, episodic, I-SNP, VBP, Medicare and Medicaid).Multi-state managed care knowledge and familiarity with state regulations.

Expert in contract negotiations, contract literacy and data analysis capabilities.

Current understanding of healthcare issues that can impact reimbursement.

Skilled at building relationships and collaborating across interdisciplinary departments.

Physical Demands Primarily sedentary work performed in an office or remote work environment.

Prolonged periods of sitting, working on a computer, and participating in virtual and in-person meetings.

Frequent use of a computer, keyboard, telephone, and other standard office equipment.

Ability to read, analyze, and interpret detailed contracts, financial reports, reimbursement data, and other documents.

Frequent verbal communication required for negotiations, presentations, training, and collaboration with payers, facility leaders, and internal stakeholders.

Occasional standing, walking, bending, reaching, and lifting of office materials up to 15 pounds.

Ability to travel periodically to skilled nursing facilities, corporate offices, payer meetings, conferences, or training events as business needs require.

Must be able to maintain focus and attention to detail while reviewing complex contractual, financial, and operational information.

Ability to work extended periods at a computer and manage multiple projects, deadlines, and priorities simultaneously.

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