Managed Care Contracting Liaison

Managed Care Contracting Liaison

Join Our Team as a Managed Care Contracting Liaison Build Strong Payer Partnerships and Support Reimbursement Success Across Texas

Were seeking an experienced and relationship-focused Managed Care Contracting Liaison to join our team and serve as a key connection between our skilled nursing facilities (SNFs) and managed care organizations, Medicare Advantage plans, and Texas Medicaid managed care programs, including STAR+PLUS. This position plays a vital role in supporting contract negotiations, rate management, network participation, authorizations, and payer relationships across an assigned portfolio of Texas SNFs. If you have strong knowledge of healthcare reimbursement, payer contracting, and Texas managed care programs and enjoy solving complex issues through collaboration and negotiation, this role is for you.

Your Impact as a Managed Care Contracting Liaison

In this role, you will:

• Support Contract Negotiations: Assist with the negotiation, renewal, and amendment of managed care and Medicare Advantage contracts, including rate schedules, per diem structures, case rates, and value-based or risk arrangements.
• Analyze Contract Terms: Evaluate proposed contract terms using facility cost data, payer mix, and market benchmarks, and provide recommendations to leadership regarding acceptable rates and terms.
• Manage Contract Data: Maintain an accurate contract matrix tracking effective dates, rate terms, renewal deadlines, termination clauses, and other key contract details.
• Build Payer Relationships: Serve as a primary liaison with MCO network development, provider relations, and utilization management representatives, including Texas STAR+PLUS MCOs and Medicare Advantage plans.
• Strengthen Network Partnerships: Develop and maintain payer relationships that support timely admissions, authorizations, issue resolution, and effective communication.
• Coordinate Payer Meetings: Partner with key payers to review performance, denial trends, contract compliance, and opportunities for improvement.
• Resolve Authorization Issues: Work closely with facility admissions, case management, and business office teams to address authorization delays, level-of-care disputes, and concurrent review issues.
• Support Denials Management: Track and analyze denial patterns and payer scorecards, escalating systemic concerns through appropriate contracting channels.
• Navigate Medicaid Requirements: Assist facilities with Texas Medicaid managed care prior authorization and utilization review requirements.
• Maintain Regulatory Knowledge: Stay current on Texas HHSC Medicaid managed care requirements, STAR+PLUS program rules, and CMS Medicare Advantage regulations affecting SNF network participation and reimbursement.
• Support Compliance: Help ensure contract terms align with applicable Texas Medicaid managed care requirements and CMS network adequacy standards.
• Partner with Legal and Compliance: Coordinate contract language reviews and support the organization in responding to regulatory and payer-related changes.
• Prepare Reports: Develop reports on contract status, rate comparisons, payer mix trends, and network participation for facility administrators and corporate leadership.
• Monitor Reimbursement: Compare reimbursement rates against Medicaid fee-for-service benchmarks and regional market rates.
• Support Budgeting: Provide payer mix, contract rate, and reimbursement data to support annual budgeting and rate-setting processes.
• Coordinate Across Facilities: Manage multiple priorities and maintain effective communication across an assigned portfolio of skilled nursing facilities.

What You Bring to the Team

• Clinical Credential: Current Texas LVN or RN license in good standing with the Texas Board of Nursing.
• Industry Experience: 3+ years of experience in managed care contracting, payer relations, or healthcare reimbursement, preferably within long-term care or skilled nursing.
• Texas Medicaid Knowledge: Working knowledge of Texas Medicaid managed care programs, including STAR+PLUS and applicable Texas HHSC contracting requirements.
• Payer Experience: Experience working directly with Texas Medicaid MCOs and/or Medicare Advantage plans.
• SNF Reimbursement Knowledge: Understanding of Medicare Advantage network participation and skilled nursing reimbursement methodologies.
• Contracting Expertise: Experience reviewing and negotiating payer contract language, rate exhibits, and amendments.
• SNF Network Experience: Prior experience contracting specifically for skilled nursing or long-term care networks with Texas MCOs.
• Denials & Utilization Knowledge: Experience with denials management and utilization review escalation processes.
• Payer Relationships: Established relationships with Texas MCO network development or provider relations teams.
• Analytical Skills: Strong analytical abilities with proficiency in Excel; experience with contract management or reimbursement software is a plus.
• Communication Skills: Excellent relationship-management, negotiation, written, and verbal communication skills.
• Problem-Solving: Strong ability to identify issues, develop solutions, and manage appropriate escalation.
• Organization: Ability to coordinate multiple facilities, priorities, contracts, and payer relationships effectively.
• Travel Flexibility: Ability to travel as needed to skilled nursing facilities across an assigned Texas region.

Working Environment

• Collaborative Leadership: Work closely with facility administrators, corporate leadership, reimbursement teams, admissions, case management, business office staff, compliance, and legal teams.
• Payer Engagement: Regular interaction with managed care organizations, Medicare Advantage plans, and other payer representatives.
• Regional Travel: Travel may be required to SNFs, payer meetings, conferences, and other business locations throughout Texas.
• Flexible Meetings: Participation in virtual or in-person meetings outside normal business hours may occasionally be required based on payer or organizational needs.
• Independent Work: Manage multiple priorities and work independently with minimal supervision while maintaining strong communication and follow-through.

Benefits (Full-Time)

• Comprehensive Coverage: Health, Dental, and Vision Insurance
• Extra Protection: AD&D, Short-Term Disability, Cardiac, Cancer, Critical Illness, Hospital Confinement
• Life Insurance: Whole and Term Policies
• Professional Growth: Tuition Reimbursement for continued education
• Time to Recharge: Paid Time Off
• Retirement Planning: Immediate 401(k) eligibility
• Unwavering Support: Exceptional corporate resources

Equal Opportunity Employer

We are an equal opportunity employer and prohibit discrimination/harassment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

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