Managed Care Resource
$110,000–$130,000 year
On-siteLong Beach, California, United States
Job Summary
Establish and evaluate strategic plans to optimize financial performance through rates and increased census. Engage in complex contract development and negotiation with health plans, physicians, and hospitals, ensuring timeliness and rate appropriess. Identify and maintain effective relationships with contracted health plans and regulatory agencies while managing high-profile negotiations. Assist in analyzing amendments, reimbursement, and language changes to improve cost positions and market penetration. Strategize for facility census growth and retention, then teach and train facility personnel on operationalizing contracts. Interact with staff on utilization, clinical results, and managed care census. Present at facilities weekly and travel up to 80% of the time.
Required Qualifications
- Location: Candidate must reside in the Los Angeles, CA area
- Willing to travel up to 80% of the time (as deemed appropriate)
- Present in facilities on a weekly basis, (currently as deemed appropriate)
- Pre-employment criminal background screening required
- A bachelor's degree in business administration, management or health care administration
- At least 2 years of experience with Managed Care contracting in a Senior Living/Skilled Nursing or Long-Term Care community
- 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
- Ability to deal with responsibility with confidential 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, plan, and handle multiple tasks/demands simultaneously
- Excellent verbal and written communication skills
- Excellent critical thinking skills
- Computer savvy (Contract Logix, MS Word, MS Outlook & Excel)
- Ability to be flexible, be readily adaptable, and work in a rapidly and constantly changing environment
Desired 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 in a Senior Living/Skilled Nursing or Long-Term Care community, highly desired
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