Managed Care Director - Chicago IL

About the Organization

This company provides consulting and guidance to short and long term care skilled nursing facilities and assisted living communities across the Chicagoland area. They foster a culture of caring to go along with career growth opportunity, fantastic employee benefits, and a desire to provide world class services to clients.

The Direct of Managed Care is Responsible for…

• Interacting with internal leadership to identify and resolve contract pricing and strategic managed care objectives.
• Developing and maintaining relationships with senior contacts at health plans to facilitate business development opportunities and resolve financial issues related to contracts and government reimbursement.
• Ensuring all facilities are in compliance with MCO requirements.
• Maintaining all facility credentialing is up to date (i.e CLIA, JHACO, licensing, etc.)
• Participating in external meetings with clients to present feedback related to contract management performance, workflow management, and strategy.

What is Required?

• Exceptional knowledge in managed care compliance and negotiation skills.
• Highly knowledgeable in case management practices and protocol (InterQual and Milliman Care Guidelines).
• Highly knowledgeable in Managed Care Delivery systems, forms, reports, etc.
• Ability to read, understand, interpret, and apply Contract/Level of Care (per diem) and exclusion components/rates within each Managed Care contract to maximize reimbursement.
• Ability to work in data systems/Electronic Medical Records (EMR).