Managed Care Contracting Manager

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Pennant

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2016

🏥 Healthcare

⚕️ Healthcare Insurance

🧘 Wellness

Healthcare • Healthcare Insurance • Wellness

Pennant is a company dedicated to providing healthcare services, with a focus on life-changing service, culture, and leadership. They support independent operating subsidiaries that offer home health care, hospice, assisted living, independent living, and memory care. Their mission is to empower local leaders with resources and tools to deliver high-quality care. Pennant operates 103 home health and hospice agencies and 51 senior living communities across several U. S. states, including Arizona, California, and Texas. They emphasize a strong company culture guided by core values that prioritize customer service, accountability, and intelligent risk-taking.

📋 Description

• Support Home Health, Hospice, Private Duty, and Senior Living Facility leaders with managed care contracting and revenue enhancement strategies. • Negotiate managed care payer contract rates and terms. • Develop managed care relationships and negotiate contracts for new locations. • Update contracts for new services and manage contract terminations. • Analyze contract terms, rates, margins, risks, and advantages with Legal and Finance teams. • Plan and direct tactical plans supporting expansion into managed care relationships. • Identify, develop, and maintain relationships with managed care payors and healthcare regulatory agencies. • Provide guidance and training to Field Operations partners. • Monitor industry changes and market trends to identify opportunities to increase and protect managed care revenue. • Coordinate issues including contract cancellations, denials, and appeals. • Serve as the internal managed care subject matter expert for operational and Service Center leadership. • Teach, train, and advise operational leadership on administering managed care contracts. • Assist Accounts Receivable teams with high-level managed care claims issues and projects. • Distribute key contract terms and rates for new and existing managed care payer contracts.

🎯 Requirements

• Bachelor’s degree in business administration, management, or health care administration preferred. • 5+ years’ experience in managed care contracting with a managed care payer or provider organization. • Knowledge of the managed care environment, including Medicare Advantage, Commercial, and Managed Medicaid products. • Knowledge of Accountable Care Organizations and value-based purchasing strategies. • Knowledge of managed care payer contract language, terms, standard requirements, and negotiated rate methodology. • Strong analytical, problem-solving, critical-thinking, prioritization, planning, and multitasking skills. • Ability to communicate complex financial matters concisely and professionally. • Excellent verbal and written communication skills and attention to detail. • Maintain confidentiality and comply with HIPAA. • Knowledge of Home Health, Hospice, Private Duty, and Assisted Living Facility operations is a plus. • Knowledge of CPT-4, HCPCS, Revenue, and ICD coding. • Strong computer skills, including MS Word, MS Outlook, and Excel; Smartsheet knowledge is a plus. • Ability to work collaboratively, flexibly, and adapt in a rapidly changing environment. • Must be able to travel.

🏖️ Benefits

• Personal and professional development • Equal opportunity employment • Travel associated with the role