Fully Remote Director of Managed Care – Multi-Facility SNF

Nightingale; Garfield Heights (OH); À distance; USD 110 000 - 160 000; Plein temps

Avantages offerts par ce poste

Fully remote

Competitive compensation

Résumé du poste

Nightingale is seeking a Director of Managed Care to oversee prior authorizations, payer coordination, and utilization management across six skilled nursing facilities in Arkansas and Ohio. The role is fully remote, requiring deep expertise in Medicare Advantage and commercial plans and strong cross-team collaboration with MDS, nursing leadership, and regional teams.

You will optimize reimbursements, monitor authorization timelines, and resolve denials while maintaining compliant documentation

Qualifications

• Deep background in Managed Care, Utilization Review, Prior Authorization, or MDS within SNF/LTC.
• Strong understanding of Medicare Advantage and commercial plans.
• Excellent communication, follow-through, and problem-solving skills.

Responsabilités

• Manage and process all prior authorizations for admissions, continued stays, therapy services, and specialty care.
• Serve as the primary contact for managed care organizations, insurance plans, and payer representatives.
• Monitor authorization timelines, length of stay, and payer requirements to ensure compliance.
• Collaborate daily with MDS, nursing leadership, therapy, admissions, and regional leadership.
• Track, resolve, and appeal denials, ensuring complete and accurate documentation.
• Provide clear, consistent communication to facility teams regarding authorization status and next steps.
• Identify trends, barriers, and opportunities to strengthen managed care outcomes.
• Maintain organized workflows and reporting across all six facilities.

Connaissances

Managed Care

Utilization Review

Prior Authorization

MDS

Communication

Remote work

Description du poste

Nightingale is seeking a Director of Managed Care to oversee prior authorizations, payer coordination, and utilization management across six skilled nursing facilities in Arkansas and Ohio. The role is fully remote, requiring deep expertise in Medicare Advantage and commercial plans and strong cross-team collaboration with MDS, nursing leadership, and regional teams.

You will optimize reimbursements, monitor authorization timelines, and resolve denials while maintaining compliant documentation