Payor Relations Manager

Overview

Territory: Texas & Louisiana

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 FunctionsDevelop 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 referralsCapture 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 goalsDevelop tools for area leaders to educate branches, reiterate preferred payor targets, and align with account expectationsCommunicate 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 payorPartner with AVP of Payor Strategy for any enhanced rate requests and associated documentsMap out and maintain organization charts for assigned MCOsIdentify any resources that need to be included in the payor landing page for myAveanna.netOversight of compliance for any MCO required reportsCoordinate with business development team for major account referrals tied to assigned MCOsEncourage ongoing communication between branch locations and contacts each MCODevelop practice efficiencies that benefit Aveanna and assigned MCOsAttend regularly scheduled meetings to develop and review weekly, monthly, and quarterly goalsRequirements2+ years experience with MCO authorization processComprehensive knowledge of all Aveanna business lines and ability to articulateBasic Understanding of claims life cycleFundamental understanding of healthcare benefits (HMO, PPO, ACO, Medicare, Medicaid, etc.)Experience in public speakingAdditional state specific requirements:Understanding of state regulations that govern our practices and those of the MCOsParticipation and advocacy with state industry associationsPreferencesExperience with Private Duty Nursing utilization request processesProven sales track recordExtensive knowledge of the Private Duty Nursing industryBasic contracting and credentialing knowledgePrevious leadership skillsOther Skills/AbilitiesProficient in Microsoft Word, Excel, and PowerPointFamiliarity with company EMR functionsEffective problem-solving and conflict resolutionExcellent organization and communication skillsEnvironmentMultiple branch locations within coverage area of MCOComfortable presenting industry and Aveanna specific knowledge with high level employees at MCOsPerforms duties in an office environment during agency operating hoursVaccination RequirementsAs 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.