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Clinical Managed Care Manager

Company: Ensign Group
Location: La Mesa
Posted on: November 18, 2021

Job Description:

Ensign Services, Inc. is seeking a Managed Care Consultant. We currently have opportunities in Northern California and portions of Southern California. 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. Why Ensign * National leader in the growing healthcare industry. * We are a unique company with a flat structure that allows our independent affiliates to make decisions that best fit them. * What sets Ensign Services apart from other companies is the quality of our most valuable resource - our people. * We take our core values of Customer Second, Accountability, Passion for Learning, Love One Another, Intelligent Risk Taking, Celebration, and Ownership (CAPLICO) seriously and strive to provide a work experience that proves it. * ESI provides service and support to over 230 facilities in the long term care continuum that employ over 30,000 team members across 14 states. * High volume, fast paced environment. * Publicly traded - NASDAQ: ENSG. Total Rewards 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. Primary Duties * 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. * Analyzing historical and current data trends, based on trends and analysis provide detailed operational instruction to individual facilities. * Assist in analysis and coordination of amendments, reimbursement, and language changes. * 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. * Monitor industry changes, trends and events to proactively identify opportunities to increase market penetration and performance improvement. * 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. Required Skills * ---Knowledge of managed care contracting language, requirements, and methods to support the development and maintenance of contract compliance, contract language review and contract analysis. * Strong analytical mind, with problem solving skills, an aptitude for accuracy, and attention to detail. * Must be knowledgeable about the managed care environment; including capitation, PPO, HMO, IPA, ACO, DCE and POS. * Expert in Skilled Nursing Managed care plans. * Experience in successful operationalizing managed care contracts in the skilled nursing environment. * Present in facilities on a weekly basis. Desired Qualifications * Must live California * Must have prior experience working in a skilled nursing setting * Minimum 5 years' experience with Managed Care contracting * Preference for bachelor's degree in business administration, management or health care administration * Willing to travel up to 75% of the time 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. Back to Jobs

Keywords: Ensign Group, La Mesa , Clinical Managed Care Manager, Healthcare , La Mesa, California

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