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Form of workPosition 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
An Equal Opportunity Employer
