Director of Managed Care Contracting RN/LPN

Job Description

Job Description

Director of Managed Care Contracting RN/LPN
Hybrid Remote/Office Position

Are you ready to launch your career with a dynamic and growing healthcare company?

If you’re ready for the challenge, YOU could be the right fit for this position! We are seeking a top-notch Director of Managed Care Contracting RN/LPN who has a strong work ethic, exceptional organization skills, attention to detail, and the desire to acquire and apply new skills within our fast-paced environment.

Prestige is ready to welcome you as our managed care champion to oversee and direct the development, maintenance, and negotiation of managed care contracts with various health plans and payors in multiple states and nationally.

We offer a rewarding experience to work with other warm-hearted team members, while at the end of each day, your professional success and personal fulfilment will be your reward for making a difference in the lives of our residents.

Summary: Oversees and directs the development, maintenance, and negotiation of managed care contracts with various health plans and payors in multiple states and nationally. Leads strategic payer relationship management efforts and supports the advancement of company programs aligned with value-based care, including Accountable Care Organizations (ACOs) and Institutional Special Needs Plans (I-SNPs).

Qualifications:Experience:

• 5+ years’ experience in long term care managed care contracting.
• Multi-state/national managed care contracting background.
• LPN/RN Preferred
• Previous case management experience preferred.
• Extensive knowledge and experience with Accountable Care Organizations and value-based care reimbursement models.

Job Functions:

• Serves in a leadership role in addressing a wide, complex spectrum of managed care provider relationships and contracting.
• Innovative in developing new managed care and provider network business partnerships and reimbursement enhancements.
• Maintaining and strengthening existing managed care and provider network business partnerships.
• Responsible for initiating, developing, negotiating, and monitoring of managed care and provider network contracts on behalf of the organization.
• Negotiate new business, payment rates and structures, and key aspects of contract language directly with VPs, Medical Directors, C-Suite, and other executives of managed care organizations.
• Cultivates and manages strategic relationships with payors to strengthen collaboration, resolve operational challenges, and drive optimal contract performance.
• Collaborates with internal stakeholders to design, enhance, and monitor the performance of value-based care initiatives such as ACOs and I-SNPs.
• Supports the operational execution of risk-bearing contracts by providing payer insight and fostering cross-functional alignment across clinical, contracting, and operational teams.
• Other duties as assigned

Knowledge/Skills/Abilities:

• Ability to read and write in English at a level appropriate for the job.
• Ability to communicate effectively with residents and their family members, and at all levels of the organization.
• Ability to be accurate, concise, and detail-oriented
• Ability to read, speak, understand, and communicate effectively in English through verbal and written means