Director Managed Care Analytics

UNC Health; Morrisville (NC); On-site; USD 150,000 - 190,000; Full time

Job summary

UNC Health is seeking a high-level analytics executive to serve as the HCS System Director of Managed Care Analytics. This role focuses on evaluating payer rates, contracting strategy, and financial analysis across local, regional, and national payer relationships within UNC Health’s system.

The incumbent will optimize contract performance, support population health and value-based models, and lead governance across executive leadership and payers, with emphasis on strategic planning and

Qualifications

• Education Requirements: Master’s degree in an appropriate discipline.
• Professional Experience Requirements: Seven years of managed care experience.
• Knowledge/Skills/and Abilities Requirements: Understands and applies principles, procedures, requirements, regulations, and policies related to specialized expertise.

Responsibilities

• Strategic - Leads development and implementation of system-wide Managed Care strategy with senior leaders and external stakeholders to drive growth and profitability.
• Operational – Oversees monthly, quarterly, and annual management processes, financial modeling for contract negotiations, and payer performance data analysis.
• Leading People - Fosters an inclusive workplace, develops talent, delegates effectively, and maintains accountability for results.
• Leading Change - Acts as a catalyst for organizational change, sets vision, adapts to changing conditions, and mitigates risks.
• Results Driven - Delivers high-quality, timely, cost-effective results and supports continuous improvement in patient care.

Job description

Description

Your passion belongs at UNC Health. Join more than 56,000 teammates working together to improve the health and well-being of the communities we serve across North Carolina.

Summary:

The HCS System Director of Managed Care Analytics serves as the Health Care System's top analytics executive responsible for evaluating payer rates and is a key part of the managed care executive team responsible for strategy development, financial analysis, and contract negotiation of local, regional, and national strategic payer relationships. All payer relationships that require contracting across our system are in the scope of responsibility for the position. Key areas of focus include assessment, negotiation, implementation, and management of: commercial fee-for-service and value-based managed care payer contracts; Medicare Advantage and Managed Medicaid managed care fee-for-service and value-based payer contracts; narrow network public and private exchange payer contracts; military (Tricare, VA) contracts; specialty and carve-out payer contracts, single case agreements, center of excellence designation programs, and other partnership opportunities with payers as required.

The HCS System Director of Managed Care Analytics will optimize the organization's contract performance with its contracted payers to maximize the organization’s financial viability while also advancing the system’s population health and value-based payment model strategies.

Responsibilities:

1. Strategic - The HCS System Director of Managed Care Analytics is a key part of the executive team that leads the development and implementation of system-wide Managed Care strategy. This requires working closely with senior leadership (primarily system level and entity specific CFOs, CEOs, and physician executives) at all entities while fostering effective working relationships with payers, employer groups, associations, and other internal and external stakeholders with the goal of working in alignment to generate industry leading outcomes. Directs all analysis pertaining to external payers (e.g., national/regional insurance carriers) on behalf of UNC Health’s owned and managed hospitals, professional groups, and ancillary business units including joint ventures such as ambulatory surgery centers. The position is part of a core executive team that evaluates and executes opportunities that drive growth and profitability for UNC Health under both fee for service and value-based alternative payment concepts. The position is a strategic thought leader both internally and in the broader marketplace. Contributes to collaboration, integration, and performance improvement activities with revenue cycle and clinical operations to achieve strategic, financial, and operational performance goals while also searching out and advocating for new tools and processes to drive greater ability to ensure the organization’s requirements are met in a timely and accurate manner.

2. Operational – The HCS System Director of Managed Care Analytics is responsible for developing and overseeing monthly, quarterly, and annual management processes including but not limited to business reviews and strategy processes for Managed Care. Managed Care related operational responsibilities include assurances that contractual rate increases happen on time and accurately for all entities, financial modeling for contract negotiations, creation and dissemination of payer performance data, maintenance of contract builds in Epic, and negotiations including new agreements and amendments. The position oversees these functions as well as developing, analyzing, and interpreting financial, operational, and strategic metrics to assist the System Chief Financial Officer, Chief Revenue Officer, System VP of Managed Care, Executive Director of Managed Care and other UNC Health executives with effective performance management and decision making in addition to supporting the ongoing growth of our system.

3. Leading People - Leads people toward meeting the organization's vision, mission, and goals. Provides an inclusive workplace that fosters the development of others, facilitates cooperation and teamwork, and supports constructive resolution of conflicts. Encourages workforce engagement by building a commitment to excellence and by promoting the organization's vision internally and externally. Delegates’ responsibility clarifies expectations and holds others accountable for achieving results related to their area of responsibility. Leads in a deliberate and predictable way and operates with transparency. Treats sensitive or confidential information appropriately. Develops the ability of others to perform and contribute to the organization by providing ongoing feedback and by providing opportunities to learn through formal and informal methods. Manages and resolves conflicts and disagreements in a constructive manner.

4. Leading Change - Acts as a catalyst for organizational change. Influences others to translate vision into action. Brings about strategic change, both within and outside the organization, to meet organizational goals. Establishes an organizational vision and implements it in a continuously changing environment. Is open to change and new information and rapidly adapts to new information, changing conditions, or unexpected obstacles. Deals effectively with pressure and remains optimistic and persistent, even under adversity. Recovers quickly from setbacks. Formulates objectives and priorities, and implements plans consistent with the long-term interests of the organization. Capitalizes on opportunities and manages risks. Takes a long-term view and builds a shared vision with others.

5. Results Driven - Exceeds organizational goals and customer expectations. Makes decisions that produce high-quality results by applying technical knowledge, analyzing problems, and calculating risks. Holds self and others accountable for measurable high-quality, timely, and cost-effective results. Delivers high-quality services and is committed to continuous improvement. Fosters a culture of safe and compassionate patient care. Makes well-informed, timely decisions, even when data are limited or solutions produce unfavorable results. Positions the organization for success by identifying new opportunities and builds the organization by developing and improving services.

Other Information

Other information:

• Education Requirements: Master's degree in an appropriate discipline.
• Licensure/Certification Requirements:
• Professional Experience Requirements: Seven years of managed care experience.
• Knowledge/Skills/and Abilities Requirements: Understands and applies principles, procedures, requirements, regulations, and policies related to specialized expertise.

Job Details

Legal Employer: NCHEALTH

Entity: Shared Services

Organization Unit: Managed Care

Work Type: Full Time

Standard Hours Per Week: 40.00

Salary Range: Pay offers are determined by experience and internal equity

Work Assignment Type: Hybrid

Work Schedule: Day Job

Location of Job: US:NC:Morrisville

Exempt From Overtime: Exempt: Yes

This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care; except that, if you are currently a UNCHCS State employee already working in a designated shared services department, you may remain a UNCHCS State employee if selected for this job.

Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.

UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email [e-mail] if you need a reasonable accommodation to search and/or to apply for a career opportunity.