Managed Care Specialist

    Nexion Health
    Richardson, TX
    Full-time, Part-time

    Job Description

    Managed Care Specialist

    Nexion affiliates operate skilled nursing and rehabilitation as well as assisted living facilities in Colorado, Louisiana, Mississippi and Texas. Each of our affiliate skilled nursing and assisted living campuses offers a home-like setting influenced by their own unique regional cultures. Our commitment to excellence is reflected in our positive clinical outcomes, resident and family member testimonials, satisfaction reports and AHCA Quality Awards.

    Job Summary:

    The Managed Care Specialist establishes and implements the company-wide managed care strategy. This may include the identification and prioritization of payors by market; determining the viability of a given payor agreement; ability to leverage hospital performance and payor agreements across otherwise disparate markets; negotiation and re-negotiation of payor agreements; and the harvesting and communication of performance data so as to stimulate payor negotiation referrals.

    Essential Functions:
    • Develops an annual managed care strategic and tactical plan and educates staff on the plan. Ensures the strategic and tactical plan is carried out and oversees tactical efforts to achieve plan components over the course of the plan period. Performs an annual of assessment of plan success.
    • Maintains effective communication of relevant managed care-related developments across the industry.
    • Negotiates and/or oversees the negotiation of viable managed care agreements according to established criteria. Initializes all agreements in an accurate and timely fashion across all company databases.
    • Routinely analyzes existing agreements and takes appropriate action which may include renegotiation, termination, etc.
    • Serves as a direct resource for Nexion staff and encourages them to stimulate referrals. Provides a centralized out-of-network conversion resource as a means of protecting rate integrity and added leverage towards viable payor agreements.
    • Develops and maintains effective working relationships with managed care organizations, referring hospital managed care executives and as necessary, hospital physician leadership.
    • Leads the company effort to harvest and report selected performance data and encourages the development and submission of case-specific touch-points to payors in an effort to demonstrate Nexion's value to the payor and to stimulate payor-driven referrals.
    • Negotiates viable purchased service agreements with community/tertiary hospitals in an effort to minimize and control the costs of care otherwise sponsored by Nexion as provide by non-Nexion institutional providers.
    • Provides primary support with respect to graphics and marketing brochures.
    • Regular attendance and timeliness is required.
    • This description is a general statement of required essential functions performed on a regular and continuous basis. It does not exclude other duties as assigned.
    • Supervision: Directs the activities and the staff of the department.
    • Experience: Minimum of five years of experience developing and implementing managed care contracts in multi-market health care systems. Experience negotiating system-wide contracts as both payor and provider is preferred.
    • Education: Bachelor's degree in Health Administration or business-related field required.
    • Licensure/Certification: Certification in the American Hospital of Healthcare Executives preferred.
    We offer competitive salaries and great benefits, including 100% Paid Vacation/Sick time, Medical, Dental, Vision, 401k, FSA, STD/LTD, Life Insurance and AD and D.

    EOE M/F/D/V

    Posting ID: 552773996Posted: 2020-05-21