Director of Managed Care

Job Summary

This position manages, negotiates, and optimizes reimbursement agreements between skilled nursing facilities (SNFs) and managed care organizations.

The Director of Managed Care maintains relationships with existing managed care plans, identifies new managed care payers in the states and markets we serve, and educates our SNFs on how to operationalize contracts.

Key Responsibilities


* Negotiate new managed care agreements with health plans, the VA, and hospitals, including exclusions, add-ons, levels of care, lines of business, and terms.


* Evaluate contracts for financial viability against operational costs and analyze existing agreements to determine whether rates should be renegotiated or the contract is still viable; consult with the Administrator/Regional Vice President on next steps.


* Lead initiatives to increase managed care PPD and expand health plan contract networks, including identifying and securing relationships with new health plans and specialized service lines.


* Serve as the primary liaison between health plans, SNF teams, and supporting internal departments, and participate in Operations, Health Plan, and team meetings virtually and in person.


* Track and monitor SNF compliance with health plan metrics and contracting requirements, including ALOS, RTA, clinical outcomes, star ratings, and other plan requirements.


* Review managed care PPD trends and collaborate with Regional Operations and Administrators on the best ways to operationalize contracts; educate Admissions, Marketing, Case Management, Billing, and Administrators to ensure smooth contract implementation and accurate reimbursement.


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


* Maintain a database of managed care agreements and SNF access.


* Partner with Managed Care Credentialing, other internal PACS departments, and the PACS Legal Department to maintain documents required for contracts and review contract language as needed.


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

Requirements


* Minimum of 8 years of healthcare contracting experience, preferably within skilled nursing


* Bachelor's degree in business or a healthcare-related field


* Primarily sedentary work in an office or remote environment, including prolonged periods of sitting, computer use, and virtual and in-person meetings; occasional lifting of office materials up to 15 pounds.

Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions of the position.


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


* Familiarity with SNF operations highly preferred


* Profound understanding of SNF reimbursement methodologies (PDPM, levels of care, ep...