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Clinical Managed Care Manager job in Whittier at Ensign Services

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Clinical Managed Care Manager at Ensign Services

Clinical Managed Care Manager

Ensign Services Whittier, CA Full Time
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Ensign Services, Inc. is seeking a Clinical Managed Care Manager. We currently have opportunities in Northern California and portions of Southern California.

About the Company:

ESI currently serves 232 health care operations including skilled nursing facilities, assisted living facilities, and other ancillary service providers. These operations have no corporate headquarters or traditional management hierarchy. Instead, they operate independently with support from the “Service Center,” a world-class service team that provides centralized legal, human resource, training, accounting, IT and other resources necessary to allow on-site leaders and caregivers to focus on day-to-day care and business issues in their facilities and operations.

About the Opportunity:

The Clinical Managed Care Manager 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.

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.
  • 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 Qualifications:

  • 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.

Preferred 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.

[ Link removed ] - URL blocked - click to apply

 

Recommended Skills

Managed Care
Analysis
Appeals
Claims
Cpt Coding
Coordinating

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Job Snapshot

Employee Type

Full-Time

Location

Whittier, CA

Job Type

Health Care, Nurse

Experience

Not Specified

Date Posted

06/12/2021

Job ID

JR39809
Apply to this job.
Think you're the perfect candidate?
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