Payor Relations Manager

Overview

Territory:
West - California, New Mexico, Washington

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.

• 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
• 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

• 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

• Understanding of state regulations that govern our practices and those of the MCOs
• Participation and advocacy with state industry associations

• 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

• Proficient in Microsoft Word, Excel, and Power Point
• Familiarity With Company EMR Functions
• Effective problem-solving and conflict resolution
• Excellent organization and communication skills

• 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

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.