Managed Care Resource

JOB SUMMARY

The Managed Care Resource will support our Home Health, Hospice, Private Duty and Senior Living Facility leaders in managed care contracting and revenue enhancement strategies for all healthcare payers as well as assist in the preparation for changes in the healthcare industry.The Managed Care Resource will negotiate managed care payer contract rates and terms and provide guidance with regards to the development of managed care relationships, ensuring timeliness and appropriateness of negotiated rates. Additionally, the Resource will negotiate contracts for new locations, assist with ensuring that contracts are updated for new services, manage contract terminations, conduct managed care education sessions and develop and implement a strategic vision to assist in accelerating the results of the Operations they will support.

DUTIES & RESPONSIBILITIES

• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Engage in complex levels of contract development and negotiation with managed care payors, including but not limited to managed care organizations, ACOs, health systems, hospitals, physician organizations, and third-party administrators, while working with the Legal and Finance teams in analyzing margins based on costs and rates for existing and newly acquired operations. 
• Establish, plan, direct, and evaluate the implementation of tactical plan(s) that will ensure expansion and support of business operations into managed care relationships and bring consistency of contract-related criteria and guidelines to optimize financial performance and minimize risk for operations.
• Assist in the analysis of contract terms and rates and coordinating the submission of amendments, changes in reimbursement, and language changes, and assist in advising each operation of risks and advantages of signing contracts. Identify, develop, and maintain an effective relationship with managed care payors and managed care/health care regulatory agencies. 
• Provide guidance and training when applicable to assist Field Operations partners in order to accelerate the results of the Field.
• Monitor industry changes, market trends, and events to identify opportunities to increase and protect the operations, proactively manage care revenue, as well as present as a subject matter expert with regard to applicable changes in the healthcare industry.
• Coordinate and assist each operation with any issues, such as contract cancellation and denials/appeals.
• Effectively communicate at all organizational levels and in situations requiring education, consultation, instruction, persuasion, negotiation, and advisement, as a consultant will serve as an internal managed care subject matter expert to Presidents, Executive Directors, and Service Center leadership personnel.
• Teach, train, and advise operational leadership on how to administer their managed care contracts by the creation and distribution of tools, training, and resources for leadership, AR team, Intake personnel, Case Management, and all other Operations or Service Center team members as needed.
• Assist the AR team with high-level managed care claims issues and projects to ensure the timely collection of monies due.
• Serve as primary liaison for all operations by distributing to operations and the service center all key contract terms and rates for all new and existing managed care payer contracts.

JOB REQUIREMENTS (Education, Experience, Knowledge, Skills & Abilities)

• Bachelor's degree in business administration, management, or health care administration preferred.
• 5 + years' experience in managed care contracting with a managed care payer or provider organization.
• Analytically oriented with the ability to communicate complex financial matters in a concise, professional manner.
• Must be knowledgeable about the managed care environment, including Medicare Advantage, Commercial, and Managed Medicaid products (HMO, PPO, EPO, POS, and Special Needs Plans), as well as knowledge of Accountable Care Organizations (ACOs) and value-based purchasing strategies.
• Work collaboratively as part of the Managed Care Team.
• Knowledge of managed care payer contract language and terms, standard requirements, and negotiated rate methodology to support contract compliance and analysis.
• Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously and have strong analytical and problem-solving skills with keen attention to detail and an aptitude for accuracy.
• Excellent verbal and written communication skills, as well as excellent critical thinking skills.
• Maintain confidentiality and comply with the Health Insurance Portability and Accountability Act (HIPAA).
• Knowledge of Home Health, Hospice, Private Duty, and Assisted Living Facility operations is a plus.
• Ability to be flexible, adaptable, and work in a rapidly and constantly changing environment
• Knowledge of CPT-4, HCPCS, Revenue, and ICD coding.
• Strong computer skills (MS Word, MS Outlook & Excel) with Smartsheet knowledge a plus.
• Must be able to travel.

Please note that this job description has been designed to indicate the general nature, working conditions, and level of work performed by employees within this job. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, working conditions, and qualifications required of employees assigned to this job. Duties, responsibilities, and activities may change at any time with or without notice. Additionally, the incumbent may be requested to perform job-related tasks other than those stated in this description.

Location: Nashville, TN Service Area TBD

Schedule: Hybrid

Compensation: $95,000 - $110,000
 

About the Company

Pennant Services is one of the most dynamic and progressive companies in the rapidly expanding senior living, home health, hospice, and home care industries. Affiliates of Pennant Services now operate over 150 senior living, home health, hospice, and home care operations across 14 states, and we are growing These operations have no corporate headquarters or traditional management hierarchy. Instead, they operate independently with support from the "Service Center," a world-class service team that provides the centralized clinical, legal, compliance, risk management, HR, training, accounting, IT, and other resources necessary to allow on-site leaders and caregivers to focus squarely on day-to-day care and business issues in their individual agencies.

Something else that sets us apart from other companies is the quality of our most valuable resources – our people We are dedicated to living out our culture as defined by our core values, "CAPLICO":

Customer Second

Accountability

Passion for Learning

Love One Another

Intelligent Risk Taking

Celebrate

Ownership

By incorporating these principles at all levels of our organization, our employees feel valued and excited about their impact on our service center team members and operational partners. Our culture fosters personal and professional excellence and promotes development that leads to continued success.

The employer for this position is stated in the job posting.  The Pennant Group, Inc. is a holding company of independent operating subsidiaries that provide healthcare services through home health and hospice agencies and senior living communities located throughout the US.  Each of these businesses is operated by a separate, independent operating subsidiary that has its own management, employees and assets.  More information about The Pennant Group, Inc. is available

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