2,465 Managed Care jobs in the United States

**Job Description**
The Managed Care Compliance Specialist is responsible for assisting with the implementation of the internal auditing and monitoring program within the Managed Care department by ensuring compliance with applicable rules and regulations including but not limited to AB1455 and Medicare Claims Processing Guidelines. This position is responsible for maintaining routine auditing functions and providing feedback on departmental activities, to assure compliance with all health plan and regulatory agencies, including CMS, DMHC, and DHCS.
Duties and Responsibilities:
+ Ensures all services provided to Commercial, Medicare and Medi-cal managed care members are in compliance with program regulations, insurance regulations, and regulatory requirements.
+ Maintains and tracks laws and regulations, contract documentations, amendments, and various compliance measures pertaining to Commercial, Medicare and Medi-cal managed care.
+ Develops policies, procedures, and processes to align with federal program regulations and any applicable state regulations pertaining to Commercial, Medicare and Medi-Cal managed care.
+ Provides mentorship to various departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contract language for Commercial, Medicare and Medi-Cal managed care.
+ Acts as a liaison with health plans and current CSHS departments to ensure both health plan regulations and CSHS policies are met.
+ Coordinates and act as primary contact for all health plans audits, including leading all aspects of the review for performance management and accurate coding.
+ Develops and supervise compliance with corrective action plans as a result of post-health plan audits and regulatory audits.
+ Provides required Compliance and FWA trainings for existing, new employees and non-employees, as the need arises.
+ Educates CSHS employees on company policies and procedures regarding access to care, the grievance and appeals process, the eligibility process, etc.
+ Remains updated on all member and provider policy changes made by the health plan and/or the State.
+ Acts as subject matter expert on health care laws/regulations as a compliance resource to CSHS and affiliates, including contracted and employed physician practices.
+ Aggregates, analyze, and report audit results, identify error trends and root causes, and make recommendations for performance improvements.
**Qualifications**
**Education:**
High school diploma/GED required. Bachelor's degree in Healthcare or related field preferred.
**Experience:**
Five (5) years of compliance experience, preferably in a healthcare environment, required. Two (2) years of Medi-Cal, Medicare or Commercial Managed Care experience preferred.
**About Us**
Cedars-Sinai is a leader in providing high-quality healthcare encompassing primary care, specialized medicine and research. Since 1902, Cedars-Sinai has evolved to meet the needs of one of the most diverse regions in the nation, setting standards in quality and innovative patient care, research, teaching and community service. Today, Cedars- Sinai is known for its national leadership in transforming healthcare for the benefit of patients. Cedars-Sinai impacts the future of healthcare by developing new approaches to treatment and educating tomorrow's health professionals. Additionally, Cedars-Sinai demonstrates a commitment to the community through programs that improve the health of its most vulnerable residents.
**About the Team**
With a growing number of primary urgent and specialty care locations across Southern California, Cedars-Sinai's medical network serves people near where they live. Delivering coordinated, compassionate healthcare you can join our network of clinicians and physicians to improve the healthcare people throughout Los Angeles and beyond.
**Req ID** : 11981
**Working Title** : Managed Care Compliance Specialist - Managed Care
**Department** : MNS Managed Care
**Business Entity** : Cedars-Sinai Medical Center
**Job Category** : Strategic Plan / Business Dev
**Job Specialty** : Managed Care
**Overtime Status** : EXEMPT
**Primary Shift** : Day
**Shift Duration** : 8 hour
**Base Pay** : $34.69 - $53.77
Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law.

Managed Care Biller

Due to company growth, CommuniCare Health Services is currently recruiting a Managed Care Biller for our Corporate Managed Care Billing Department.

The position of Managed Care Biller/Collector is responsible for billing, receivables auditing, and collections activities for services provided to patients in the facilities assigned. Ultimately they are responsible for hitting their cash collection goals each month and minimizing the impact of Bad Debt for the buildings/facilities assigned to them.

All CommuniCare employees enjoy competitive wages and PTO (Paid Time Off) plans. We offer full time employees a menu of benefit options that include:

• Life Insurance and Disability Plans
• Medical, dental, and vision coverage from quality benefit carriers
• 401K with employer match
• Flexible Spending Accounts

Position Requirements:

• Knowledge of medical billing/collection practices.
• 3-5 years experience in managed care billing preferred
• Experience billing various Managed Care companies and understanding the requirements for each payor
• Claim appeal/resolution expertise preferred
• Must have a high degree of attention to detail.
• Strong verbal and written skills required in order to interact with insurance companies to resolve unpaid claims via telephone and written correspondence.
• Basic computer literacy and skills.
• Strong organizational skills a must.

About Us: A family-owned company, we have grown to become one of the nation's largest providers of post-acute care, which includes skilled nursing rehabilitation centers, long-term care centers, assisted living communities, independent rehabilitation centers, and long-term acute care hospitals (LTACH). Since 1984, we have provided superior, comprehensive management services for the development and management of adult living communities. We have a single job description at CommuniCare, "to reach out with our hearts and touch the hearts of others." Through this effort we create "Caring Communities" where staff, residents, clients, and family members care for and about one another.

Summary

Requisition ID
62077

Requisition Name
Legal Assistant

Quantity Requested
90

Submission Deadline

02/05/2024

Description

Our Client is looking to hire a Legal Assistant for an onsite role in their downtown Nashville, TN location.
No duplicate submissions.
Our Client provides their workforce with a hybrid work environment. Most positions have a combination of work from home and work in the office, which varies by position, department, and business need. However, this position is 100% onsite in their downtown Nashville, TN office.
Training is extensive, up to 6 weeks prescheduled, virtual / in-office (by supervisor request), and contractors must attend training every day to build proficiency.
No Preplanned PTO will be approved during weeks of training.
All Legal Assistant's MUST be local to middle TN and able to work in our Client's office in Nashville, TN as needed. The work hours and schedule are M-F with standard 7.5 hours per day/max, 37.5 hours per week.
Key Responsibilities

• Determine individual and family eligibility for our Client's care programs.
• Assist in coordinating and communicating schedules to internal/external Clients.
• Conduct client interviews, collect facts and information, and compile case data to provide recommendations to an attorney.
• Timely management of casework, including proper documentation and case resolution.
• Provide legal research, analysis of legal papers, and draft legal documents. Document findings accurately.
• Work efficiently / effectively in multiple databases to extract information.
• Attend workgroup meetings and participate in discussions.
• Assist leadership team, as necessary.

Requirements and Skills

• Must have a bachelor's or associate degree.
• A background in Paralegal studies is a plus.
• Work experience in a Legal environment a plus.
• Customer service or call center experience a plus.
• Proven technical skills (e.g., Microsoft Word, Excel, Outlook, PowerPoint, SharePoint, etc.).
• Excellent time management skills with the ability to prioritize work to meet specific deadlines with minimal supervision.
• Excellent verbal and written communications skills.
• Keen attention to detail and adherence to deadlines.
• Strong time management, note-taking, email organization, and distribution skills.
• Critical thinking and problem-solving skills.

Other Important Information

• The position is a 100% onsite contract in downtown Nashville, TN.
• The position is contract for 12 months with an opportunity to be extended.

Estimated Duration
05/20/2024 - 12/30/2024

Days

Monday Yes Tuesday Yes Wednesday Yes Thursday Yes Friday Yes Saturday No Sunday No

Hours/Day
7.5

Time Zone

CST

Shifts Start Time End Time Description
Active

Shift 1

8:00 AM

4:30 PM

State of Tennessee Official Standard Office Hours

Yes

Attachments File Description
Comments Comment Files Company Origin Viewable Created By Created On It is a 5-month Contract or 12 Months? CL Digital - Active Supplier Requistion ll Kumar, Pratham 01/09/2024 8:48 AM CST

Location
Position Location On Site
Address
310 Great Circle Rd. Nashville, Tennessee

Qualifications Type Category Qualification Description Competency Required Education Others Bachelor's or Associate Degree Must have a bachelor's or associate degree Proficient (4-6 Years) Yes Skills Others Critical thinking and problem-solving skills Proficient (4-6 Years) No Skills Others Communication Skills Excellent verbal and written communications skills. Proficient (4-6 Years) Yes Skills Others Microsoft Office Proven technical skills (e.g., Microsoft Word, Excel, Outlook, PowerPoint, SharePoint, etc.). Proficient (4-6 Years) Yes Skills Others Paralegal background in Paralegal studies is a plus. Novice (1-3 Years) No

UNITE HERE HEALTH serves over 200,000 workers and their families in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity!

The Managed Care Specialist role functions as the main point of contact between the operational departments of UNITE HERE HEALTH and a wide range of managed care partners (contracted network carriers, vendors, and preferred providers). This position works closely with internal departments to help identify and resolve issues, implement new benefit platforms, and overall guide the relationship between UHH and our managed care partners.

The specialist supports UHH Leadership in holding managed care partners accountable for providing the highest level of services at the lowest cost to UHH and its members. They will work towards becoming a subject matter expert on the relationships and contract terms that they are responsible for overseeing.

ESSENTIAL JOB FUNCTIONS AND DUTIES

• Build relationships with managed care partners to facilitate problem identification and resolution, set expectations and evaluates performance
• Assists with negotiating renewals with managed care partners and services providers and works to capture key initiatives in contracts
• Thorough reviews and edits of managed care contracts
• Coordinates and ensures compliance with the UHH monitoring policy
• Analyzes data and drafts resolutions for Board of Trustees approval
• Possesses a working knowledge of the Request for Proposal (RFP) process
• Contributes to identifying and providing solutions of recurring or systemic issues
• Exemplifies the Fund's values in leading and fostering a respectful, trusting, and engaged culture of inclusion and engagement

ESSENTIAL QUALIFICATIONS

• 3 to 5 years of direct experience minimally in healthcare, managed care, or insurance environments
• Working knowledge and experience in relationship building and contract negotiations
• Strong verbal communication and presenting experience
• Experience in project management processes
• Familiarity and experience working within union and Taft Hartley Funds, desired
• Bachelor's degree in Business Administration, Public Health, Healthcare Administration or related field or equivalent work experience required

Salary range for this position: Salary $70,500 - $88,200. Actual base salary may vary based upon, but not limited to: relevant experience, qualifications, expertise, certifications, licenses, education or equivalent work experience, time in role, peer and market data, prior performance, business sector, and geographic location.

Work Schedule (may vary to meet business needs): Monday~Friday, 7.5 hours per day (37.5 hours per week) as a hybrid employee.

We reward great work with great benefits, including but not limited to: Medical, Dental, Vision, Paid Time-Off (PTO), Paid Holidays, 401(k), Short- & Long-term Disability, Pension, Life, AD&D, Flexible Spending Accounts (healthcare & dependent care), Commuter Transit, Tuition Assistance, and Employee Assistance Program (EAP).

#LI-Hybrid

Position Summary

Why You'll Love Working in This Position:

• Limitless Growth: Join a rapidly expanding company where top performers are recognized and promoted. At Cedar Gate, your career potential is only limited by your ambition.
• Meaningful Work: We prioritize both employee well-being and delivering exceptional results for clients, revolutionizing healthcare.
• Flexible Work Life: Enjoy our hybrid remote schedule, which offers flexibility to balance your work productivity and dynamic personal life.
• Robust Benefits: Enjoy comprehensive medical, dental, and vision coverage, FSA/HSA options, 4% 401(k) matching, tuition assistance, generous paid time off, exclusive employee discounts, and more.
• Rewarding Culture: Work alongside a high-performing, supportive team that celebrates success together.

Summary
Join Cedar Gate Technologies as a Managed Care Specialist! We're looking for a dynamic new employee to help shape and manage our provider, payer, and facility contracts. In this role, you'll develop, negotiate, implement, monitor, and optimize managed care agreements that support our growth and quality of care. You'll stay on top of industry trends, communicate contract changes across the organization, and analyze performance data to ensure agreements deliver the expected results.

As a Managed Care Specialist, you'll also collaborate closely with internal teams, clients, payers, and providers, building strong relationships and preparing presentations - with the chance to lead or co-present on key initiatives.

Roles & Responsibilities

• Act as a key liaison between internal teams, providers, and payers - resolving managed care issues, assisting with provider communications, and researching claims to maintain strong relationships.
• Support clients, providers, and payers with a focus on timely and effective inquiry resolution.
• Build and nurture positive relationships with providers, payers, and internal stakeholders to support seamless operations.
• Research managed care trends and benchmarks to provide analysis and recommendations.
• Prepare data and insights to support negotiations with payers, employers, and providers; present findings to senior leadership.
• Coordinate and prepare all documentation for the Contract Committee and Board, ensuring accuracy and compliance.
• Assist with the review of payer and provider agreements and help develop negotiation strategies.
• Prepare and present quarterly payer account summaries to departmental leadership.
• Partner with other departments to ensure smooth workflows and accurate contract and provider information.
• Support client onboarding by managing payer and provider contract details.
• Track agreement statuses (expirations, changes, notices) and proactively alert management to required actions.
• Maintain and validate data across systems (including Cactus and other platforms) to ensure accuracy and completeness.
• Monitor payer updates in policies and procedures and distributing pertinent information to the appropriate teams in a timely manner.
• Create, organize, and maintain provider and payer contracting documents in both electronic and paper formats.
• Coordinate with provider offices to secure the timely completion of documents and distribute executed agreements properly.
• Contribute to Center of Excellence programs, including member education, helpline support, enrollment, and reporting.
• Maintain organized systems, filing structures, and resources to support department efficiency.
• Assist with special projects and additional tasks as assigned.

Job Location

Hybrid Remote: Enjoy the flexibility of working from home and collaborating three days a week at our office in Houston, Texas

Required Experience / Qualifications

• BS/BA in healthcare administration, business, finance, or related field; relevant work experience may be considered
• 3 or more years of experience in healthcare contracting or business operations, including reporting, managed care contracting, and patient account resolution with a provider or payer.
• Experience with claims payment resolution
• Strong Microsoft Office skills, including PowerPoint and Advanced Excel skills with knowledge of pivot tables, Power Queries, and complex formulas
• Superior written and verbal communication skills
• Possess a positive attitude and a willingness to learn
• Ability to work well under pressure by efficiently prioritizing and managing multiple tasks to meet performance expectations and deadlines
• Strong critical thinking and analytical skills
• Experience in analyzing and interpreting reports for financial trends in the provider contracting arena
• Self-motivated and team-oriented
• Great experience working with CPT and ICD-10 codes
• Exceptional customer service skills with a professional, businesslike image to clients, visitors, internal staff, and the public
• Currently eligible to work in the U.S. without any assistance in getting a U.S. employment visa or work authorization.

Preferences - Not Required

• Experience with Cactus, practice management system(s), and SSQ or other reporting systems
• Cardiology specialization experience

Physical Demands

This role involves a mix of desk work and light physical activity. You'll regularly sit, communicate, and handle objects, tools, or controls, as well as reach with your hands and arms. The role requires the ability to see details up close and adjust focus as needed. The ability to lift and carry up to 20 pounds, push/pull up to 25 pounds, and stand or walk for periods throughout the day is required. Reasonable accommodations are available for qualified individuals with disabilities.

Your Future Working Environment

If you join Cedar Gate, you can make great ideas happen for some of the world's most dynamic companies. With broad global resources and deep technical know-how, we collaborate with clients to cultivate ideas and deliver results in the medical industry. Choose a career at Cedar Gate and enjoy an innovative environment where challenging and interesting work is part of daily life.

Next to our excellent terms of employment and fringe benefits, we invest considerable resources to provide ongoing training that builds and extends professional, technical, and management skills in all areas. At Cedar Gate, you will operate in a professional environment where teamwork and innovation are immensely encouraged. Together with colleagues, you will work on high-impact projects for many dynamic companies.

About Cedar Gate

Cedar Gate enables payers, providers, employers, and service administrators to excel at value-based care. Our unified technology and services platform enhances and automates data management activities to deliver employer and provider analytics, care management, and payment technology necessary to pursue every payment model and optimize performance in all lines of business. From primary care attribution to bundled payments to capitation, our platform is designed to improve clinical, financial, and operational outcomes for all.

Based in Greenwich, CT, Cedar Gate is private equity backed by GTCR, a leading Chicago-based private equity firm, Ascension Ventures, a strategic healthcare venture firm, and Cobalt Ventures, the investment subsidiary of BCBS of Kansas City. To learn more, visit

About the Company

ESI currently serves over 350 health care operations that employ over 48,000 employees across 14 states. These operations have no corporate headquarters or traditional management hierarchy. Instead, they operate independently with support from the "Service Center" - a team of accounting, legal, human resources, benefits, compliance, payroll, construction, training and information technology resources. Service Center human resources employees are dedicated subject matter consultants who guide and advise field personnel. This structure allows on-site leaders and caregivers to focus on day-to-day issues in their individual operations. What sets ESI apart from other companies is the quality of our most valuable resource - our people.

About the Opportunity

The Managed Care Consultant supports the Skilled Nursing Facility leaders in managed care contracting and revenue enhancement strategies for all healthcare payers and preparation for changes in the healthcare industry. The Consultant will provide guidance regarding development of managed care relationships and rate negotiation, ensuring timeliness and rate appropriateness.

Additionally, the Consultant will negotiate contracts for new locations, assist with ensuring that contracts are updated for new services and help with contract cancellations, denials and appeals.

Essential Functions and Responsibilities

• Establish, implement and evaluate the strategic plan(s) that will ensure each local operation the ability to optimize financial performance through rates and increased census.
• Engage in complex levels of contract development and negotiation, including risk agreements using utilization, claims and market data with health plans and direct service agreements with physicians, physician organizations and hospitals and ancillary providers.
• Identify, develop and maintain an effective relationship with contracted health plans and managed care regulatory agencies.
• Manage complex and high-profile health plan negotiations. Actively draft and negotiate contracts in the health care operations and health care plan functional areas.
• Assist in analysis and coordination of amendments, reimbursement, and language changes.
• Assess resource utilization, cost management and negotiate effectively.
• Monitor industry changes, trends and events to proactively identify opportunities to increase market penetration and performance improvement.
• Understands the competitive pricing levels in the local market and improves the company's cost position through unit costs strategies.
• Strategizes for facility census growth and retention.
• Teach, Train and Instruct facility level personnel on how to operationalize the contract.
• Interact with facility personnel on utilization, clinical results and managed care census.

Qualifications:

• Knowledge of managed care contracting language, requirements, and methods to support the development and maintenance of contract compliance, contract language review and contract analysis.
• Must be knowledgeable about the managed care environment, including capitation, PPO, HMO, IPA, ACO and POS.
• Knowledge of CPT-4, HCPCS, Revenue and ICD coding.
• Expert in Skilled Nursing Managed care plans.
• Experience in successful operationalizing managed care contracts in the skilled nursing environment.
• Knowledge of contracts and contractual interpretations for payment and benefit issues.
• Working knowledge of medical terminology, claims payment, contract negotiations, and problem resolution; ability to work collaboratively in a team setting.
• Communicate effectively at all organizational levels and in situations requiring instructing, persuading, negotiating, consulting, and advising.
• Ability to deal with responsibility with confidential matters. Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
• Strong analytical mind, with problem solving skills, an aptitude for accuracy, and attention to detail.
• Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously.
• Excellent verbal and written communication skills, as well as excellent critical thinking skills.
• Computer savvy (Contract Logix, MS Word, MS Outlook & Excel).
• Ability to be flexible, be readily adaptable, and work in a rapidly and constantly changing environment.
• Present in facilities on a weekly basis, (currently as deemed appropriate).

Desired Qualifications

• Must live in Texas, preferably in the Dallas/Ft. Worth, Texas area.
• Preference for bachelor's degree in business administration, management or health care administration.
• Willing to travel up to 80% of the time (as deemed appropriate)
• Highly desire at least 2 years' experience with Managed Care contracting.

Additional Information

Wage Rate: Depending on Experience

Position Type: Full-time, exempt employee

Benefits: Medical, dental, vision, life & AD&D insurance plans, 401(k) with matching contribution, vacation, sick and holiday pay

Location: Candidate must reside in the Dallas/Ft. Worth, Texas area.

Ensign Services, Inc. is an Equal Opportunity Employer. Pre-employment criminal background screening required.

JOB SUMMARY

The Managed Care Resource will support our Home Health, Hospice, Private Duty and Senior Living Facility leaders in managed care contracting and revenue enhancement strategies for all healthcare payers as well as assist in the preparation for changes in the healthcare industry.The Managed Care Resource will negotiate managed care payer contract rates and terms and provide guidance with regards to the development of managed care relationships, ensuring timeliness and appropriateness of negotiated rates. Additionally, the Resource will negotiate contracts for new locations, assist with ensuring that contracts are updated for new services, manage contract terminations, conduct managed care education sessions and develop and implement a strategic vision to assist in accelerating the results of the Operations they will support.

DUTIES & RESPONSIBILITIES

• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Engage in complex levels of contract development and negotiation with managed care payors, including but not limited to managed care organizations, ACOs, health systems, hospitals, physician organizations, and third-party administrators, while working with the Legal and Finance teams in analyzing margins based on costs and rates for existing and newly acquired operations.
• Establish, plan, direct, and evaluate the implementation of tactical plan(s) that will ensure expansion and support of business operations into managed care relationships and bring consistency of contract-related criteria and guidelines to optimize financial performance and minimize risk for operations.
• Assist in the analysis of contract terms and rates and coordinating the submission of amendments, changes in reimbursement, and language changes, and assist in advising each operation of risks and advantages of signing contracts. Identify, develop, and maintain an effective relationship with managed care payors and managed care/health care regulatory agencies.
• Provide guidance and training when applicable to assist Field Operations partners in order to accelerate the results of the Field.
• Monitor industry changes, market trends, and events to identify opportunities to increase and protect the operations, proactively manage care revenue, as well as present as a subject matter expert with regard to applicable changes in the healthcare industry.
• Coordinate and assist each operation with any issues, such as contract cancellation and denials/appeals.
• Effectively communicate at all organizational levels and in situations requiring education, consultation, instruction, persuasion, negotiation, and advisement, as a consultant will serve as an internal managed care subject matter expert to Presidents, Executive Directors, and Service Center leadership personnel.
• Teach, train, and advise operational leadership on how to administer their managed care contracts by the creation and distribution of tools, training, and resources for leadership, AR team, Intake personnel, Case Management, and all other Operations or Service Center team members as needed.
• Assist the AR team with high-level managed care claims issues and projects to ensure the timely collection of monies due.
• Serve as primary liaison for all operations by distributing to operations and the service center all key contract terms and rates for all new and existing managed care payer contracts.

JOB REQUIREMENTS (Education, Experience, Knowledge, Skills & Abilities)

• Bachelor's degree in business administration, management, or health care administration preferred.
• 5 + years' experience in managed care contracting with a managed care payer or provider organization.
• Analytically oriented with the ability to communicate complex financial matters in a concise, professional manner.
• Must be knowledgeable about the managed care environment, including Medicare Advantage, Commercial, and Managed Medicaid products (HMO, PPO, EPO, POS, and Special Needs Plans), as well as knowledge of Accountable Care Organizations (ACOs) and value-based purchasing strategies.
• Work collaboratively as part of the Managed Care Team.
• Knowledge of managed care payer contract language and terms, standard requirements, and negotiated rate methodology to support contract compliance and analysis.
• Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously and have strong analytical and problem-solving skills with keen attention to detail and an aptitude for accuracy.
• Excellent verbal and written communication skills, as well as excellent critical thinking skills.
• Maintain confidentiality and comply with the Health Insurance Portability and Accountability Act (HIPAA).
• Knowledge of Home Health, Hospice, Private Duty, and Assisted Living Facility operations is a plus.
• Ability to be flexible, adaptable, and work in a rapidly and constantly changing environment
• Knowledge of CPT-4, HCPCS, Revenue, and ICD coding.
• Strong computer skills (MS Word, MS Outlook & Excel) with Smartsheet knowledge a plus.
• Must be able to travel.

Please note that this job description has been designed to indicate the general nature, working conditions, and level of work performed by employees within this job. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, working conditions, and qualifications required of employees assigned to this job. Duties, responsibilities, and activities may change at any time with or without notice. Additionally, the incumbent may be requested to perform job-related tasks other than those stated in this description.

Location: Nashville, TN Service Area TBD

Schedule: Hybrid

Compensation: $95,000 - $110,000

About the Company

Pennant Services is one of the most dynamic and progressive companies in the rapidly expanding senior living, home health, hospice, and home care industries. Affiliates of Pennant Services now operate over 150 senior living, home health, hospice, and home care operations across 14 states, and we are growing! These operations have no corporate headquarters or traditional management hierarchy. Instead, they operate independently with support from the "Service Center," a world-class service team that provides the centralized clinical, legal, compliance, risk management, HR, training, accounting, IT, and other resources necessary to allow on-site leaders and caregivers to focus squarely on day-to-day care and business issues in their individual agencies.

Something else that sets us apart from other companies is the quality of our most valuable resources - our people! We are dedicated to living out our culture as defined by our core values, "CAPLICO ":

C ustomer Second

A ccountability

P assion for Learning

L ove One Another

I ntelligent Risk Taking

C elebrate

O wnership

By incorporating these principles at all levels of our organization, our employees feel valued and excited about their impact on our service center team members and operational partners. Our culture fosters personal and professional excellence and promotes development that leads to continued success.

The employer for this position is stated in the job posting. The Pennant Group, Inc. is a holding company of independent operating subsidiaries that provide healthcare services through home health and hospice agencies and senior living communities located throughout the US. Each of these businesses is operated by a separate, independent operating subsidiary that has its own management, employees and assets. More information about The Pennant Group, Inc. is available at

Job Title: Managed Care Specialist

Location: Nashville, TN/Hybrid

Duration: 7+ Months
All candidates MUST be local to middle TN and able to commute to our Client's office in Nashville, TN as needed. The work hours and schedule are M-F with standard 7.5 hours per day/max, 37.5 hours per week.
Our Client is looking to hire a Managed Care Specialist for a hybrid role.

Our Client provides their workforce with a hybrid work environment. Most positions have a combination of work from home and work in the office, which varies by position, department, and business need. Training is extensive, up to 6 weeks prescheduled, virtual / in-office (by supervisor request), and contractors must attend training every day to build proficiency.

No Preplanned PTO will be approved during training weeks.

Key Responsibilities

• Determine individual and family eligibility for our Client's care programs.

• Assist in coordinating and communicating schedules to internal/external Clients.

• Conduct client interviews, collect facts and information, and compile case data to provide recommendations to an attorney.

• Timely management of casework, including proper documentation and case resolution.

• Provide legal research, analysis of legal papers, and draft legal documents. Document findings accurately.

• Work efficiently / effectively in multiple databases to extract information.

• Attend workgroup meetings and participate in discussions.

• Assist leadership team, as necessary.

Requirements and Skills

• Must have a bachelor's or associate degree.

• A background in Paralegal studies is a plus.

• Work experience in a Legal environment a plus.

• Customer service or call center experience a plus.

• Proven technical skills (e.g., Microsoft Word, Excel, Outlook, PowerPoint, SharePoint, etc.).

• Excellent time management skills with the ability to prioritize work to meet specific deadlines with minimal supervision.

• Excellent verbal and written communications skills.

• Keen attention to detail and adherence to deadlines.

• Strong time management, note-taking, email organization, and distribution skills.

• Critical thinking and problem-solving skills.

Other Important Information

• The position is a hybrid position in downtown Nashville, TN. The contractor will work onsite and remotely based on the team's schedule.

• The position is contract for 12 months with an opportunity to be extended.

**_What Managed Care contributes to Cardinal Health_**
Practice Operations Management oversees the business and administrative operations of a medical practice.
Managed Care oversees the interactions that take place between payer and provider(s) to ensure optimal reimbursement including managed care contracting, enrollment, credentialing, and any other activity as it relates to payer interaction.
The Manager of Payor Contracting is responsible for reviewing, auditing and negotiating existing and new Payor contracts with Health Insurance companies (ex. Blue Cross, Blue Shield, IPA, etc). Reporting to the Director of Managed Care, the Manager of Contracting is responsible for managing legal review, policy compliance, contract retention and administrative tracking of all various managed care payors. Advances company payor strategy and align negotiation with strategy.
**_Responsibilities:_**
+ In collaboration with the Director of Managed Care, negotiate and manage assigned contracts, including initiating, planning, finalizing, implementing, reporting (written and verbal) and directing related negotiations.
+ Proposes contracting and pricing models and strategies using knowledge of market, local and national benchmarks, and payer market. Key member of negotiating team for company.
+ Negotiates contract language across all contracts, striving for uniformity among different contracts, partnering with the General Counsel as needed and as appropriate.
+ Coordinates finance, legal and operational reviews of contracts. Coordinates sign off on all proposed terms of contracts and amendments, adhering to Company contract sign off and approval processes.
+ Adheres to all Company processes for tracking rates and terms of all contracts.
+ Is a valuable member of the team based on core business subject matter expertise, general industry knowledge and skills and interest in being a member of a team. Consults with other members of the Leadership Team on contract terms and updates to contracts that may apply to operational areas.
**_Competencies:_**
+ **Decision Making:** Ability to make decisions with significant, broad implications for the management and operations of a major department or multiple departments. Participates in decisions on overall strategy and direction of the organization.
+ **Problem Solving:** Ability to address problems that are broad, complex and abstract, often involving Medical Center-wide issues and requiring substantial creativity, resourcefulness, staff engagement, Lean diagnostic techniques, negotiation and diplomacy to develop solutions.
+ **Independence of Action:** Ability to set goals and priorities for functional area. May make recommendations for department policies, practices and programs. Manager or Director provides broad guidance and overall direction.
+ **Written Communications:** Ability to communicate complex information in English effectively in writing to all levels of staff, management and external customers across functional areas.
+ **Oral Communications:** Ability to verbally communicate complex concepts in English and address sensitive situations, resolve conflicts, negotiate, motivate and persuade others.
+ **Knowledge:** Ability to demonstrate in-depth knowledge of concepts, practices and policies with the ability to use them in complex varied situations.
+ **Team Work:** Ability to lead and direct multiple collaborative teams for large projects or groups both internal and external to the Medical Center and across functional areas. Results have significant implications for the management and operations of the organization.
+ **Customer Service:** Ability to lead operational initiatives to meet or exceed customer service standards and expectations in assigned unit(s) and/or across multiple areas in a timely and respectful manner.
**_Qualifications:_**
+ 8-12 years of experience, preferred
+ Bachelor's degree in related field, or equivalent work experience, preferred
+ 5-8 years related work experience required in Revenue cycle including Payor contracts and 1-3 years supervisory/management experience preferred
+ Negotiation and Presentation Skills.
+ Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web-based applications. May produce complex documents, perform analysis and maintain databases.
**Anticipated salary range:** $105,000 - $165,000 USD Annual
**Bonus eligible:** No
**Benefits:** Cardinal Health offers a wide variety of benefits and programs to support health and well-being.
+ Medical, dental and vision coverage
+ Paid time off plan
+ Health savings account (HSA)
+ 401k savings plan
+ Access to wages before pay day with myFlexPay
+ Flexible spending accounts (FSAs)
+ Short- and long-term disability coverage
+ Work-Life resources
+ Paid parental leave
+ Healthy lifestyle programs
**Application window anticipated to close: 12/5/2025** *if interested in opportunity, please submit application as soon as possible.
The salary range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate's geographical location, relevant education, experience and skills and an evaluation of internal pay equity.
_Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply._
_Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal_ _Opportunity/Affirmative_ _Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law._
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