Director of Managed Care

PACS

23h • $110,000 - $150,000

About The Position

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 payer violating 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. Join PACS: Elevate Healthcare with Us! PACS is elevating healthcare by revolutionizing our approach to leadership and quality care. Guided by our core values of love, excellence, trust, accountability, mutual respect, and commitment, we strive to foster a culture of compassionate care within our teams and the communities we serve. As we grow rapidly, exciting opportunities await you to engage in impactful projects and contribute valuable insights to stakeholders nationwide. If you're ready to make a difference and embrace our mission of creating real change, we invite you to join us at PACS. Together, let’s shape the future of healthcare! Join Our Team and Thrive! At PACS, we believe our employees are our greatest asset. That’s why we offer an exceptional benefits package designed to enhance your well-being and support your lifestyle. PACS is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status, or any other legally protected status. PACS is revolutionizing the delivery and leadership of post-acute healthcare and support services across the country. Originally founded in 2013, the organization now consists of hundreds of independent operating subsidiaries, as well as ancillary and support services. We bring a proven model of mission-driven care that balances access to a national network of support and resources with local decision making. In addition, PACS helps connect exceptional people with premier healthcare careers across the country. We focus on finding innovative and effective team members based on their qualifications, experience, geographic preferences, and personality fit with the existing facility staff and culture. We celebrate diversity and are committed to creating an inclusive environment for all employees. We welcome applicants of every race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, and any other protected characteristic. Employment decisions are based on qualifications, merit, and business needs.

Requirements

• 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.

Responsibilities

• 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 payer violating 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.

Benefits

• Health Coverage: Enjoy medical, dental, and vision plans to keep you and your family healthy.
• PTO and Vacation: Benefit from generous paid time off and holidays to relax and recharge.
• Financial Wellness: Take advantage of Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) to manage your healthcare expenses effectively.
• Retirement Planning: Secure your future with our 401(k) plan, complete with company contributions to help you build your retirement savings.
• Support When You Need It: Our Employee Assistance Plan (EAP) provides confidential support for personal and professional challenges.

What This Job Offers

• Job Type: Full-time
• Career Level: Director