Managed Care Consultant in San Diego, CA at Ensign Services

Date Posted: 7/31/2020

Job Snapshot

Job Description

Ensign Services, Inc. is seeking a Managed Care Consultant. We currently have opportunities in Texas.

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.

About the Company

Ensign Services, Inc. is the most progressive company in the exploding healthcare services field today, serving over 250+ long-term care facilities and other affiliated entities with over 28,000 employees.  Our affiliated entities are located across more than a dozen states, and we are continuing to grow. These operations have no corporate headquarters or traditional management hierarchy. Instead, they operate independently with support from the shared 'Service Centers', a world-class service team that provides the centralized clinical, 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.
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 company-wide, 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.
  • 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.
  • Work collaboratively as part of the Texas Managed Care team to provide Texas-wide support and training as needed.

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.
  • Must be knowledgeable about the managed care environment; including capitation, PPO, HMO, IPA, ACO and POS.
  • 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.
  • Present in facilities on a weekly basis.

Desired Qualifications

  • Must live in Northern or Southern California.
  • 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. Back to Jobs