In this article, Megan McCullough, DHSc, VP of Strategic Sales Growth at Limitlessli, shares insights from her recent conversation with Joe Russell, VP of Network Management & Contracting at Strategic Health Care. Together, they explore what’s driving the growing complexity of managed care—and how providers can fight back with both upstream strategy and downstream execution.
The Problem We’re All Facing
If you work in post-acute care, you already know: managed care authorizations are no longer just an administrative chore. They’re a full-time job.
And as Joe Russell pointed out in our recent conversation, the problem isn’t just volume—it’s complexity.
“Every plan has its own requirements, timelines, and documentation standards,” Joe told me. “When you layer in third-party conveners, it’s not always clear who is making the final decision. That’s where things slow down.”
The impact? Delays in care, frustrated staff, and a higher risk of denials.
The Authorization Bottleneck
At Limitlessli, we see the same pain points Joe described every day:
- Vague and inconsistent approval criteria
- Daily or near-daily update demands from payers
- Portals that are clunky and time-consuming
- Communication breakdowns between providers, payers, and conveners
The result?
“Our nurses have become full-time faxers and emailers instead of caregivers.”
Joe and I agree: the solution requires both better contracts and better processes.
Upstream vs. Downstream Solutions
Joe’s team at Strategic Health Care operates upstream, where the battle begins—with the payer contract. They work to:
- Negotiate patient-centered authorization protocols
- Align requirements with clinical outcomes
- Minimize unnecessary updates
- Advocate for standardized electronic tools (coming to Medicare Advantage by 2027)
“Improving the contract terms is the first line of defense,” Joe explained. “It reduces friction before it ever hits your clinical or administrative teams.”
At Limitlessli, we come in downstream—once the contracts are signed—to make sure facilities can actually execute those terms consistently, accurately, and without draining on-site resources.
Our approach includes:
- Remote authorization specialists dedicated 100% to pre-auths, concurrent reviews, and payer communication
- Payer-specific workflow mapping so your team isn’t reinventing the wheel with each request
- Centralized operations for multi-site providers to eliminate duplication and reduce errors
- Integration into existing systems so there’s no need for new tech or training overhead
The Convener Complication
As Joe pointed out, conveners are becoming more common in Medicare Advantage and value-based care models. They’re supposed to streamline utilization management, but too often, they create more confusion.
Are you talking to the payer? Or the convener? Who’s reviewing your documentation? And how many systems do you have to update before someone makes a decision?
Our remote teams are trained to manage both payer and convener communications, ensuring nothing gets lost in translation and that every update, upload, and follow-up happens on time.
The Denial Domino Effect
Even when you get authorization, you’re not in the clear. ADRs and retrospective denials can still hit weeks—or months—later. And most of these denials aren’t about medical necessity—they’re about small administrative misses.
“The small stuff gets you denied. The stakes are high—but the reasons are petty.”
This is where Joe and I share another common philosophy: proactive prevention is the only way forward.
At Limitlessli, that means:
- Clinical documentation integrity programs
- Standardized note and query protocols
- Frequent audits for accuracy and compliance
- Analytics to spot denial trends early
Working Smarter, Not Just Harder
The truth is, no one provider can tackle this alone. As Joe says, “You need strategy in the boardroom and execution on the floor.”
Strategic Health Care brings the contract strategy.
Limitlessli delivers the operational muscle to carry it out.
Together, this upstream/downstream approach allows providers to:
- Reduce authorization delays
- Prevent avoidable denials
- Keep clinicians focused on patient care—not paperwork
Final Word
Managed care isn’t going away. But with the right partnerships, processes, and people in place, you can take control instead of just keeping up.
“Every minute spent chasing authorizations is a minute not spent with a patient.”
If your facility is ready to reduce the chaos and improve results, it’s time to rethink how you handle managed care—before it handles you.
Megan McCullough is Vice President of Strategic Sales Growth at Limitlessli, where she drives sales strategy, builds partnerships, and advances company-wide growth. With a Doctorate in Health Science and extensive leadership experience—including serving as SVP of Operations for a national therapy company—Megan combines industry insight with operational expertise. She is a sought-after speaker at state and national healthcare conferences and an active advocate for improving patient care and reducing administrative burdens for providers.
Joe Russell is Vice President for Network Management & Contracting at Strategic Health Care – Managed Care Solutions, where he supports nearly 60 post-acute providers through the Illinois Aging Services Network. With deep expertise in managed care, public policy, and advocacy, Joe has led initiatives to improve quality and value in healthcare, including founding the nation’s first community-based, clinically integrated provider managed care network. He has held leadership roles in home care, hospice, and developmental disability services, and has a strong background in Medicaid and legislative affairs. Joe holds a bachelor’s in political science from the University of Toledo and is a Certified Association Executive.
