Job Summary

This position manages, negotiates, and optimizes reimbursement agreements between skilled nursing facilities (SNFs) and managed care organizations. The Director of Managed Care maintains relationships with existing managed care plans, identifies new managed care payers in the states and markets we serve, and educates our SNFs on how to operationalize contracts.

Key Responsibilities

• Negotiate new managed care agreements with health plans, the VA, and hospitals, including exclusions, add-ons, levels of care, lines of business, and terms.
• Evaluate contracts for financial viability against operational costs and analyze existing agreements to determine whether rates should be renegotiated or the contract is still viable; consult with the Administrator/Regional Vice President on next steps.
• Lead initiatives to increase managed care PPD and expand health plan contract networks, including identifying and securing relationships with new health plans and specialized service lines.
• Serve as the primary liaison between health plans, SNF teams, and supporting internal departments, and participate in Operations, Health Plan, and team meetings virtually and in person.
• Track and monitor SNF compliance with health plan metrics and contracting requirements, including ALOS, RTA, clinical outcomes, star ratings, and other plan requirements.
• Review managed care PPD trends and collaborate with Regional Operations and Administrators on the best ways to operationalize contracts; educate Admissions, Marketing, Case Management, Billing, and Administrators to ensure smooth contract implementation and accurate reimbursement.
• Partner with AR to resolve high-dollar managed care reimbursement issues when escalation attempts have been unsuccessful.
• Maintain a database of managed care agreements and SNF access.
• Partner with Managed Care Credentialing, other internal PACS departments, and the PACS Legal Department to maintain documents required for contracts and review contract language as needed.
• Ensure all contracts comply with internal and external mandates and/or regulations.

Requirements

• Minimum of 8 years of healthcare contracting experience, preferably within skilled nursing
• Bachelor’s degree in business or a healthcare-related field
• Primarily sedentary work in an office or remote environment, including prolonged periods of sitting, computer use, and virtual and in-person meetings; occasional lifting of office materials up to 15 pounds. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions of the position.
• Ability to travel periodically to skilled nursing facilities, corporate offices, payer meetings, conferences, or training events as business needs require
• Familiarity with SNF operations highly preferred
• Profound understanding of SNF reimbursement methodologies (PDPM, levels of care, episodic, I-SNP, VBP, Medicare, and Medicaid)
• Multi-state managed care knowledge and familiarity with state regulations
• Expert in contract negotiations, contract literacy, and data analysis
• Current understanding of healthcare issues that can impact reimbursement
• Skilled at building relationships and collaborating across interdisciplinary departments
• Ability to make independent decisions and influence change without direct authority
• Self-motivated, with the ability to manage and prioritize multiple projects and deadlines with a high degree of accuracy and attention to detail

Work Location

·       This role may be performed in an office or remote work environment.

Join PACS: Elevate Healthcare with Us!

PACS is elevating healthcare by revolutionizing our approach to leadership and quality care. Guided by our core values of love, excellence, trust, accountability, mutual respect, and commitment, we strive to foster a culture of compassionate care within our teams and the communities we serve. As we grow rapidly, exciting opportunities await you to engage in impactful projects and contribute valuable insights to stakeholders nationwide.

If you're ready to make a difference and embrace our mission of creating real change, we invite you to join us at PACS. Together, let’s shape the future of healthcare!

Join Our Team and Thrive!

At PACS, we believe our employees are our greatest asset. That’s why we offer an exceptional benefits package designed to enhance your well-being and support your lifestyle.

Our Comprehensive Benefits Include

• Health Coverage: Enjoy medical, dental, and vision plans to keep you and your family healthy.

• PTO and Vacation: Benefit from generous paid time off and holidays to relax and recharge.

• Financial Wellness: Take advantage of Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) to manage your healthcare expenses effectively.

• Retirement Planning: Secure your future with our 401(k) plan, complete with company contributions to help you build your retirement savings.

• Support When You Need It: Our Employee Assistance Plan (EAP) provides confidential support for personal and professional challenges.

Join us at PACS and take advantage of a workplace that truly values you!

We celebrate diversity and are committed to creating an inclusive environment for all employees. We welcome applicants of every race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, and any other protected characteristic. Employment decisions are based on qualifications, merit, and business needs.