• Payor Relations Manager

    Aveanna Healthcare (San Diego, CA)


    Payor Relations Manager

     

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    Job Details

    Requisition #:

    212604

    Location:

    San Diego, CA 92101

    Category:

    Sales

    Salary:

    $75,000.00 - $80,000.00 per year

    Position Details

    Territory: West - California, New Mexico, Washington

    Position Overview

    The Payor Relations Manager is a highly specialized sales professional who works with our branch and area leadership to develop a strategic plan for growing relationships with assigned Medicaid Managed Care Organizations. The Payor Relations Manager reports directly to the AVP of Payor Strategy. The Payor Relations Manager is responsible for owning relationships within all of case management and utilization management departments. This individual will work with AVPs of Payor Relations, RVPs of Business Development, and AVP of Payor Strategy to develop a plan focused on volume growth, enhanced rate opportunities, and alternative payment model strategies.

     

    Essential Job Functions

     

    Develop and own relationships with all case management and utilization management departments within assigned payor accounts.

    Hold weekly or monthly meetings with MCO delegates to provide updates on existing patients and referrals

    Capture and maintain metrics for all assigned MCOs outside of what ABI can produce (staffing ratios, referral conversion, speed to care, etc.)

     

    Collaborate with AVP of Payor Strategies, AVP of Payor Relations, and RVP of Business Development to develop primary (volume) and secondary growth goals

     

    Develop tools for area leaders to educate branches, reiterate preferred payor targets, and align with account expectations

     

    Communicate regularly with all branch location personnel to assure we are aligned on all partnership opportunities with assigned payors (it is critical to our efforts to be entrenched in all facets of our branch operations)

     

    Coordinate with locations on any operational barriers and case interventions that need to be escalated to the payor

     

    Partner with AVP of Payor Strategy for any enhanced rate requests and associated documents

    Map out and maintain organization charts for assigned MCOs

    Identify any resources that need to be included in the payor landing page for myAveanna.net

     

    Oversight of compliance for any MCO required reports

     

    Coordinate with business development team for major account referrals tied to assigned MCOs

     

    Encourage ongoing communication between branch locations and contacts each MCO

     

    Develop practice efficiencies that benefit Aveanna and assigned MCOs

     

    Attend regularly scheduled meetings to develop and review weekly, monthly, and quarterly goals

    Requirements

    2+ years experience with MCO authorization process

     

    Comprehensive knowledge of all Aveanna business lines and ability to articulate

    Basic Understanding of claims life cycle

    Fundamental understanding of healthcare benefits (HMO, PPO, ACO, Medicare, Medicaid, etc.)

     

    Experience in public speaking

    Additional state specific requirements:

    Understanding of state regulations that govern our practices and those of the MCOs

     

    Participation and advocacy with state industry associations

     

    Preferences

     

    Experience with Private Duty Nursing utilization request processes

     

    Proven sales track record

     

    Extensive knowledge of the Private Duty Nursing industry

     

    Basic contracting and credentialing knowledge

     

    Previous leadership skills

     

    Other Skills/Abilities

     

    Proficient in Microsoft Word, Excel, and PowerPoint

     

    Familiarity with company EMR functions

     

    Effective problem-solving and conflict resolution

     

    Excellent organization and communication skills

     

    Environment

     

    Multiple branch locations within coverage area of MCO

     

    Comfortable presenting industry and Aveanna specific knowledge with high level employees at MCOs

     

    Performs duties in an office environment during agency operating hours

    Vaccination Requirements

    As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in all relevant jurisdictions, including required vaccinations and testing, subject to exemptions for medical or religious reasons as appropriate.

     

    As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in all relevant jurisdictions, including required vaccinations and testing, subject to exemptions for medical or religious reasons as appropriate.

     

    Notice for Job Applicants Residing in California (https://www.aveanna.com/CaliforniaPrivacyNotices.html)

     

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