Managed Care Resource Jobs

Purpose of Your Position: To establish, implement, and evaluate the strategic plan(s) and managed care contracting and partnership opportunities that will ensure each logical operation to build preferred provider partnerships with external partners (i.e. Healthplan, Managed Care delegated entities – ACOs, IPAs) and Value Based entities in order to optimize financial performance and market share growth supported by strong clinical programs.
About Us: Quorum Services supports a list of diverse ancillary companies, including mobile radiology, staff assisted dialysis, respiratory therapy, long term pharmacy and medical transportation, which including EMS and Medical flights.
Quorum Services currently serves five different business lines with more than 800 employees and growing rapidly. In 2021 we improved our performance by 600% and 2022 is set to exceed that pace. The operations within these business lines 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 the centralized legal, risk management, HR, training, accounting and IT resources necessary to allow the on-site leaders to focus on the day-to-day business in their operations. If this sounds like the career for you and you’re a candidate willing to work with various businesses and be an amazing team player please apply, we would love to meet you!
We are looking for to actively live our Core Values in the daily performance of your job. The Core Values are: CELEBRATION, ACCOUNTABILITY, PASSION FOR LEARNING, LOVE ONE ANOTHER, INTELLIGENT RISK TAKING, CUSTOMER SECOND AND OWNERSHIP.
DUTIES AND RESPONSIBILITIES:
All duties and responsibilities shall be performed as set forth in our established policies and procedures.
Adheres to and assures compliance with Code of Conduct, facility policies and procedures and all applicable rules, regulations and standards as promulgated by Federal, State, and accrediting agencies or regulating bodies. This includes, but is not limited to, Department of Health, Centers of Medicare and Medicaid Services, and other applicable regulatory agencies.
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 with physician organizations and hospitals and ancillary providers for Managed Care
Identify, develop, and maintain an effective relationship with contracted health plans and managed care regulatory agencies. Facilitate with Operations and IDT Joint Operating Committee collaboration meetings
Manage complex and high-profile health plan negotiations. Actively draft, review, and negotiate contract language and reimbursement on behalf of the health care operations health care plan functional areas
Lead 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 improved the company’s cost position through unit costs strategies
Strategizes for facility census growth and retention
Educate and Multiple facility IDT staff and Resources on how to operationalize the contract
Proactive communication to the Operations and Service Center on new contracts, amendments and changes shared by the specific Healthplan or delegated Managed Care Contract partners (ACOs, IPAs, VBP, etc.) for the Facility and supporting Market Resources to optimize contract terms and conditions
KNOWLEDGE, SKILLS & ABILITIES:
Knowledge of managed care contracting language, requirements, and methods to support the development and maintenance of contract compliance, contract language review and contract analysis
Be knowledgeable about the managed care environment; including Lines of Business (LOB) including but not limited to Medical Advantage, Commercial, Exchange, Managed Medicaid Dual, and Special Needs plans as well as familiar with different reimbursement methodologies including but not limited to Medicare current SNF reimbursement, Per Diem, Capitation, and Value Based incentive
Knowledge of CPT-4, HCPCS, Revenue, and ICD coding
Be knowledgeable about the managed care environment; including Lines of Business (LOB) including but not limited to Medical Advantage, Commercial, Exchange, Managed Medicaid Dual, and Special Needs plans as well as familiar with different reimbursement methodologies Per Diem, Capitation, and Value Based Incentive.
Experience with managed care contracting for ancillary services and professional services
Knowledge of contracts and contractual interpretations for payment and benefit issues
Working knowledge of medical terminology, claims payment, contract negotiations, and proactive problem resolution; ability to work collaboratively in a team setting. Communicate effectively (written and verbal) at all organizational level and with external partners
Must be able to read, write, speak, and understand the English language
Must possess the ability to make independent decisions when circumstances warrant such action
Must possess the ability to deal tactfully with personnel, residents, family members, visitors, government agencies/personnel, external partners, and the general public
Must have patience, tact, a cheerful disposition, and enthusiasm. As well as a willingness to handle difficult situations and bring solution to the table in collaboration with Operations and the Service Center.
Occasional throughout the market with additional travel to other Markets or the Service Center
Be knowledgeable about the managed care environment; including Lines of Business (LOB) including but not limited to Medical Advantage, Commercial, Exchange, Managed Medicaid Dual, and Special Needs plans as well as familiar with different reimbursement methodologies Per Diem, Capitation, and Value Based Incentive.
Job Type: Full-time
Pay: $80,000.00 - $120,000.00 per year
Benefits:
401(k)
401(k) matching
Dental insurance
Employee assistance program
Employee discount
Flexible schedule
Flexible spending account
Health insurance
Health savings account
Life insurance
Paid time off
Professional development assistance
Tuition reimbursement
Vision insurance
Schedule:
8 hour shift
Monday to Friday
Education:
Bachelor's (Preferred)
Experience:
Managed care: 3 years (Required)
Work Location: Remote