Job Title: Corporate Director of Managed Care

Department: Accounts Receivable

Purpose:

The Director of Managed Care oversees the development and management of various care management programs that support Avante's health strategy.

The position works in partnership with management staff who perform utilization management, complex case management, and the system intake center for managed care programs. Serves as the key leader for medical management operations and accountable care relationships with other payers. Collaborates with clinical and operational leadership to develop and implement innovative care management operations and solutions. Provides oversight of performance of care management programs. Employs direct communication, site visits, information distribution, staff education and problem solving to develop relationships, and obtain feedback. Coordinates with Avante's leadership regarding community resources and specialty services.

Job Functions:

• The Director of Managed Care oversees the designated Case Managers at the facility level. This position will oversee communication of all required ongoing documentation among staff and the administration. Interacts frequently with internal departments and external customers/vendors, particularly in problem resolution.

• Assists in developing an innovative and robust case management program. Oversees utilization trends. Develops and implements methods and procedures for monitoring work activities, enhance patient outcomes and informs management of current work activity status. Maintains current knowledge regarding skilled nursing healthcare market and industry issues that may impact the business. Plans and oversees education for case managers and applicable Revenue Cycle departments throughout the system to educate departments concerning contract terms, language, and compliance.

• Manages the tactical execution of short- and long-term objectives through the coordination of activities with a direct responsibility for results, including costs, and methods. Assists with designing Quality Improvement Projects that will improve outcomes in facilities that are not meeting goals.

• Work collaboratively with all Revenue Cycle functional areas to meet stated goals and objectives for days sales outstanding (DSO), bad debt and collection levels

• Performs all other duties as assigned.

Qualifications:

• Must possess a current, unencumbered, active license to practice as a Licensed Practical Nurse (LPN) in Florida.

• Must meet the additional educational and experience requirements outlined below.

• Experience in working in management-level positions in health care industry.

• Must be able to read, write, speak, and understand the English language.

• Must be at least eighteen (18) years of age.

• Must be a supportive team member, contribute to and be an example of teamwork and team concept.

• Must possess the ability to make independent decisions when circumstances warrant such action.

• Must possess the ability to deal tactfully with personnel, residents, family members, visitors, government agencies/personnel, and the public.

• Must be able to work in a constant state of alertness and in a safe manner at all times.

Education

• Must possess, at a minimum, an LPN Nursing license from an accredited nursing school, college, or university.

• Eight (8) years' experience working in management-level positions in the health care industry.

• Case Management, Health Plan with Medicare/Medicaid experience preferred.