Managed Care Resource

About the Company

ESI currently serves over 300 health care operations that employ over 45,000 employees across 13 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.

This role requires frequent travel, up to 50% (dependent on needs), to states within this role's scope of business with occasional work from home opportunities.

Essential Functions and Responsibilities

• Establish, implement and evaluate the strategic plan(s) 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 that are delegated for managed care.
• 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. Ability to successfully lead value base contracting initiatives.
• 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.
• Understand the competitive pricing levels in the local market and improves the company's cost position through unit costs strategies.
• Strategize for facility census growth and retention.
• Lead managed care contracting initiatives for our acquisitions.
• Teach, Train and Instruct facility level personnel on how to operationalize the contract. Development and maintain key tools to assist facility to operationalize contract terms and conditions.
• Interact with facility personnel on utilization, clinical results and managed care census.
• Work collaboratively as part of the Managed Care team with the Interdisciplinary team partners (IDT) to provide support and training as needed.

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 capitated/delegated; Networks: PPO, HMO, IPA, POS; and value-based contracting with Healthplan and ACO/IPA delegated to manage managed care membership on behalf of Healthplan.
• 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.
• Comfortable leading in-person training in front of large groups.
• 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, as well as excellent critical thinking skills.
• Computer savvy (MS Word, MS Outlook & Excel).
• Ability to be flexible, be readily adaptable, and work in a rapidly and constantly changing environment.

Additional Information

Wage Rate: $90,000 - $120,000 dependent on experience; may be eligible for bonus

Position Type: Full-time, exempt employee

Benefits: Medical, dental, vision, life & AD&D insurance plans, 401(k) with matching contribution, vacation, sick and holiday pay

Location: Candidate must reside in Washington, Idaho or Salt Lake City

Ensign Services, Inc. is an Equal Opportunity Employer. Pre-employment criminal background screening required.