Managed Care Consultant in San Juan Capistrano, CA at Ensign Services

Date Posted: 8/31/2020

Job Snapshot

Job Description

Ensign Services, Inc. is seeking a Managed Care Consultant. We currently have opportunities in Northern California and portions of Southern California. This is NOT a remote position - candidates will need to reside in 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.

About the Company

Ensign Services, Inc. currently serves 300 health care operations that employ over 36,000 employees across 17 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 personnel are dedicated subject matter consultants who guide and advise field leaders. This structure allows on-site leaders and caregivers to focus on day-to-day issues in their locations.

What sets Ensign Services apart from other companies is the quality of our most valuable resource - our people. We take our core values of Celebration, Accountability, Passion for Learning, Love One Another, Intelligent Risk Taking, Customer Second, and Ownership (CAPLICO) seriously and strive to provide a work experience that proves it!

Total Rewards

We are committed to providing a competitive Total Rewards Package that meets our employees’ needs.

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 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.
  • 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.

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