Brookdale Senior Living

  • Manager, Managed Care Contracting

    Job Locations US-TN-Brentwood
    Category
    Finance
    Requisition Post Information* : External Company URL
    https://www.brookdale.com/en.html
    ID
    2019-28861
    Location : Name
    Post Acute Bus Dev_Intgrtn-NSH
    Location : Address
    111 Westwood Place
    Location : Location
    US-TN-Brentwood
  • Overview

    Every day is an opportunity for our associates to deeply connect with people in a profound and personal way. Our associates are the core of our mission and we know that offering them genuine rewards and heart filling job satisfaction is the key to our success as a company. Here you’ll find opportunities to grow your career at any level whether you have direct contact with resident or support someone who does, and be inspired personally. With over 60,000 associates, there’s a place for you to make a difference in lives of the families we serve throughout our continuum of care.

    Responsibilities

    The position will be responsible for developing provider agreements for our post-acute and senior housing operations including skilled nursing, home health and outpatient therapy services.  These provider agreements will be with Managed Care Organizations (MCOs).  MCOs include but are not limited to Medicare Advantage Plans, HMOs, PPOs, Third Party Intermediaries, Medicaid and Accountable Care organizations.  The Contracting Manager will assume responsibilities for all aspects of contract negotiations including contract prospecting, contract soliciting, contract language/rate negotiations and contract execution.  The Contracting Manager will work closely with various Brookdale operations that credential Brookdale providers and assist in smooth functioning/implementation of executed agreements.    

    1. Solicit provider agreements from Managed Care Organizations (MCO). 
    2. Review/propose MCO contract language.
    3. Conduct complex MCO negotiations.
    4. Negotiate reimbursement rates with MCOs.
    5. Work with other Brookdale associates on credentialing and provider enrollment functions.
    6. Monitor contract performance; work closely with Brookdale providers to manage contract implementation. 
    7. Keep abreast of applicable changes relative to contracting. 
    8. Assist in development of systems, processes and policies for improved contracting. 
    9. Develop strategic plans in conjunction with appropriate business development, sales and operations teams to optimize payor management relations and management for sufficient referral and admissions trends. 
    10. Educate and advise Regional and/or Community teams on managed care contract guidelines, stipulations, requirements and billing considerations as needed for improved managed care payor relations and reimbursement. 
    11. Proactively identify and make recommendations on needed global managed care strategic development for occupancy growth. 
    12. Develop, complete and update as necessary, reports and analyses to identify trends and opportunities for managed care operational improvements to include but not be limited to market penetration and market share opportunities as well as utilization or rate analysis for both occupancy growth and improved reimbursement.
    13. Serves as a key leader in understanding the impact of healthcare reform in Brookdale and works directly with Brookdale’s Sales, Marketing & Business Development staff and executive teams to create and implement a system-strategic approach to current and future healthcare reform initiatives, especially as it relates to Managed Care.
    14. Will position Brookdale to proactively adopt innovative approaches in collaborating with payors on relationships and contracting strategies; such proactive approaches include seeking out and following thru to completion on direct contacts with MCOs and participation in other quality/value based purchasing initiatives.  
    15. Responsible for leadership, coordination and performance of activities relating to managed care, including the rapidly emerging area of Managed Care in Assisted Living communities. 
    16. Will supervise other associates in the department as well as engagement in the analysis, maintenance, negotiation, renegotiation and management of relationships and agreements with current/prospective purchasers of healthcare services.

     

    This job description represents an overview of the responsibilities for the above referenced position.  It is not intended to represent a comprehensive list of responsibilities.  An associate should perform all duties as assigned by his/her supervisor.

    Qualifications

    Education and Experience
    Bachelor’s degree and at least 3 years of Managed Care contracting experience in a provider or MCO organization.  Prior experience working in a fast-paced publicly traded company a plus.

     

    Certifications, Licenses, and Other Special Requirements
    None

     

    Management/Decision Making
    Applies existing guidelines and procedures to make varied decisions within a department.  Uses sound judgment and experience to solve moderately complex problems based on precedent, example, reasonableness or a combination of these.

     

    Knowledge and Skills
    Knowledge of post-acute payment systems and protocols for public and privately funded programs, an understanding of regulations, methods and procedures for selling Brookdale’s services to MCOs.  Ability to read, analyze and interpret complex documents.  Ability to respond effectively to inquiries or complaints.  Ability to work on contractual documents using accepted techniques and contracting styles.  Ability to apply mathematical operations to such tasks as frequency distribution, determination of test reliability and validity, and basic statistical analysis.  Ability to apply principles of logical or scientific thinking to a wide range of intellectual and practical problems.  Ability to deal with nonverbal symbolism such as formulas, scientific equations and graphs.  Ability to deal with a variety of abstract and concrete variables. 

     

    Physical Demands and Working Conditions

    • Standing
    • Requires interaction with co-workers, residents or vendors
    • Walking 
    • Sitting
    • Occasional weekend, evening or night work if needed to ensure shift coverage
    • Use hands and fingers to handle or feel
    • On-Call on an as needed basis
    • Reach with hands and arms
    • Talk or hear
    • Ability to lift: Up to 25 pounds
    • Vision

     

    Brookdale is an equal opportunity employer and a drug-free workplace.

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