Director of Managed Care (Project Management)

General Purpose

Administers and directs all aspects of managed care, which includes maintaining relationships with existing managed care plans, identifying new managed care payers in states/markets served, guidance to SNFs to increase referrals, providing day to day leadership in developing and executing financial strategy for managed

care contracts in conjunction with Director of Managed Care.

Essential Duties

• Directs and performs contract negotiations with managed care payers including rates and terms.

• Analyzes existing managed care agreements to determine if rates need to be renegotiated, or if contract

needs to be terminated. Provide consultation with operations to determine desired next steps.

• Monitors existing managed care agreements with SNFs if meeting plan requirements for ALOS, RTA%,

outcomes, Star Ratings or other plan requirements.

• Maintains database of managed care agreements and SNF access.

• Support and educate regional operation teams and SNFs on all new contracts, contract changes and

contract clarification of terms. Review unique strategies to garner support in individual markets.

• Develop, manage and sustain cooperative working relationships with payers including responding to payer requests for documents.

• Act as a liaison, when necessary and requested, to assist in solving claim issues, particularly when payerviolating contractual terms.

• Develop and analyze payer contract activity when requested by SNF or identified as a concern.

• Reviews managed care PPD trends identified and communicates findings with Regional Ops and SNF operator.

• Reviews/Analyzes P&L and/or participates in Ops calls/mtgs to determine if SNF capturing managed

care exclusions.

• Coordinates communications between managed care payer and clinical, case management, admissions, business development and business offices at SNFs.

• Monitor credentialing with MNS with updating COIs, Licenses, 2567s, Business Licenses, etc.

• Manages, assesses SNF Hospice Agreements and recommends rates, etc. Maintain database of agreements.

• Completes initial managed care payer agreements credentialing in conjunction with MNS.

• Coordinates with Legal Department VA/SAM registrations. • Manages and establishes VA Agreements for SNFs, including VA contract extensions. Analyzes Level of Care rate percentages with SNF operator before finalizing agreement.

Education and/or Experience

• Bachelor's Degree in business or healthcare related field with minimum 5 years of healthcare experience and 3 years of managed care experience.
• Self-motivated and has the ability to manage and prioritize projects. High degree of accuracy and mental awareness.
• Ability to make accurate independent decisions, influence change without direct authority using good negotiation skills. Familiar with SNF operations, practices and procedures.
• Current knowledge of managed care in multiple states and ability to model agreements with services and capabilities offered at the SNFs.
• Current understanding of healthcare issues, trends, business development opportunities. Working knowledge of state and federal law, rules and regulations which apply to government, commercial, Workers Compensation and VA reimbursement for SNFs.