Managed Care Resource

About the Company

Our growing company serves over 350 health care operations that employ over 48,000 employees across 14 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. The Consultant will provide guidance regarding development of managed care relationships and rate negotiation, ensuring timeliness and rate appropriateness.

Additionally, the Consultant will negotiate contracts for new locations, assist with ensuring that contracts are updated for new services and help with contract cancellations, denials and appeals.

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.
• 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.
• 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.
• Understands the competitive pricing levels in the local market and improves the company's cost position through unit costs strategies.
• Strategizes for facility census growth and retention.
• Teach, Train and Instruct facility level personnel on how to operationalize the contract.
• Interact with facility personnel on utilization, clinical results and managed care census.

Qualifications :

Desired Qualifications

Additional Information

Wage Rate : Depending on Experience

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 the Charlotte, NC area.

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