Payor Relations Manager

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.

Essential Job Functions
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 myAveanna.net
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

Requirements
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

Additional state specific requirements:
Understanding of state regulations that govern our practices and those of the MCOs
Participation and advocacy with state industry associations

Preferences
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

Other Skills/Abilities
Proficient in Microsoft Word, Excel, and PowerPoint
Familiarity with company EMR functions
Effective problem-solving and conflict resolution
Excellent organization and communication skills

Environment
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

Vaccination Requirements
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.

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.