Job Details

Position Summary

The Division Contracts and Credentialing Specialist leads the efforts in contract negotiations and analysis for Medicaid, managed care and other ancillary/payor source contracts as assigned of all facilities in the division in accordance with all laws, regulations, and LCCA standards. Reports to the Division Controller.

Education, Experience, and Licensure Requirements

• Bachelor's degree in business or healthcare field from accredited college (or equivalent experience)
• Five or more years experience in managed care contracting in the insurance or provider setting
• Prior healthcare experience - skilled nursing preferred
• Familiar with professional community

• Willing and able to travel extensively
• Excellent verbal and written communication skills
• Proficient with Word, Excel, and e-mail
• Able to multi-task
• Able to implement contracts at facility level
• Knowledgeable of managed care practices and procedures as well as laws, regulations, and guidelines governing managed care functions in long-term care
• Plan, organize, develop, implement and interpret programs, goals, objectives, policies, and procedures of the managed care department

• Work closely with facilities to implement profitable managed care contracts
• Educate divisional, regional and facility staff in aspects of managed care and cost containment
• Review contracts annually and negotiate optimal rates for contract levels
• Serve as liaison between managed care organization and facilities to problem-solve issues and ensure cost-effective services are provided and favorable outcomes obtained
• Read, write, speak, and understand the English language
• Understand and follow company policies, including harassment and complaint procedures
• Practice dependable, regular attendance
• Concentrate and use reasoning skills and good judgment
• Communicate and function in an interdisciplinary team
• Sit, stand, bend, lift, push, pull, stoop, walk, and move intermittently during working hours