MANAGED CARE Contractor(multi-state)
Ensign Services, Inc. is seeking a Managed Care Contractor in the Seattle, WA area! We currently have opportunities for our Washington/Idaho/Nevada markets.
About the Opportunity
The Managed Care Contractor 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 Contractor will provide guidance regarding development of managed care relationships and rate negotiation and value based contracting, ensuring timeliness and rate appropriateness.
Additionally, the Contractor will negotiate contracts for new acquisitions, assist with ensuring that contracts are updated for new services and help with contract cancellations, denials and appeals.
About the Company
Ensign Services, Inc. is the most progressive company in the exploding healthcare services field today, serving 230+ long-term care facilities and over 40 home health and hospice agencies, with over 30,000 employees in sixteen states. These operations have no corporate headquarters or traditional management hierarchy. Instead, they operate independently with support from the shared "Service Centers", a world-class team that provides the centralized legal, 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 operations.
What sets Ensign Services apart from other companies is the quality of our most valuable resource-our people. On a daily basis, we focus on living out our Culture:
- C – Celebration
- A – Accountability
- P – Passion for Learning
- L – Love One Another
- I – Intelligent Risk Taking
- C – Customer Second
- O – Ownership
The incorporation of these principles at all levels of our organization allows our employees to feel valued and excited about their impact on the operational partners and service center team members. Our culture fosters excellence personally and professionally and promotes development that leads to continued success.
We are committed to providing a competitive Total Rewards Package that meets our employees’ needs. From a choice of medical, dental and vision plans to retirement savings opportunities through a 401(k), company match and various other features, we offer a comprehensive benefits package. We believe in great work and we celebrate our employees’ efforts and accomplishments both locally and companywide, recognizing people daily through our Moments of Truth Program. In addition to recognition we believe in supporting our employee’s professional growth and development. We provide employees a wide range of free e-courses through our Learning Management System as well as training sessions and seminars.
- 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. Experience with Value Based contracting.
- 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.
- Ability to work effectively in a multi- state assigned service area (WA, ID & NV) as well as collaborate with the other managed care consultants for the entire company managed care strategies.
- 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 all lines of business Medicare Advantage, Commercial, Managed Medicaid and Dual programs as well as ACO and Value Based initiatives impacting managed care contracts.
- 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.
- Telecommute position with the flexibility to travel to multiple States for Healthplan meetings and market meetings.
- Preference to live in Washington (Seattle service area).
- Preference for bachelor’s degree in business administration, management or health care administration.
- Willing to travel 75% of the time.
- Minimum 5 years’ experience with Managed Care contracting.
The employer for this position is stated in the job posting. Ensign Services, Inc. provides recruiting services for operations in the skilled nursing, assisted living, home health and hospice industries.
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