Director, Managed Care Contracting

Wakemed; Raleigh (NC); On-site; USD 180,000 - 240,000; Full time

Job summary

Wakemed seeks a Director of Managed Care Contracting to lead the contracting function for hospital and facility payer agreements. You will drive budgeting, contract modeling, negotiations, and compliance reporting while building strategic relationships with area managed care plans.

The role oversees a portfolio of contracts, develops payment models, and ensures alignment with governmental and commercial payors. A senior leader will collaborate with CFO and finance teams to optimize outcomes.

Qualifications

• Bachelor's degree in Business Administration, Healthcare Management, or Accounting.
• Advanced knowledge in managed care contracting and financial analysis.

Responsibilities

• Lead and negotiate hospital and facility managed care contracts.
• Oversee budgeting, analysis, and contract modeling for payer contracts.
• Develop contracting strategy and oversee STRATA-based what-if modeling.
• Coordinate with CFO and finance teams to ensure data integrity and reporting.

Skills

Contracting

Finance knowledge

Education

Bachelor's Degree

Master's Degree

Job description

Overview

The Director, Managed Care Contracting is responsible for utilizing business and industry expertise, accepts responsibility for all activities in the Managed Care department applying to and impacting WakeMed facilities' managed care contracts including: budgeting, analysis, contract modeling, negotiation meetings and monitoring and reporting of payor contracts' compliance. Directs organizations efforts at building relationships with area managed care plans. Directly manages and develops a portfolio of managed care contracts. Directs contracting strategy for hospitals, HealthPlexes, hospital outpatient departments, Home Health and Rehab divisions. Develops payment models for facility managed care contracts. Oversees facility what-if modeling analysis performed in STRATA modeling tool. Oversees the following noncontracting Managed Care responsibilities: hospital contract loading in EPIC, hospital payment variances, facility credentialing. Works with CFO, Vice President of Finance, Finance Directors and financial analysts to analyze feasibility of different payment methodologies/utilization patterns and the impact on WakeMed. Monitors market trends and competitive managed care products to develop strategy recommendations. Works with WakeMed's accountable care organization to coordinate contracting efforts and outcomes beneficial to WakeMed providers. When requested, interfaces with external and third party auditors; prepares and defends contract questions and challenges; maintains quality of work and creates value through knowledge and experience with governmental regulations and processes. Adheres to service and workforce excellence by maintaining knowledge of third-party regulations (CMS, NCDHHS, DOI, etc.) for all payors, including governmental and commercial payors. Oversees problem solving related to contract terms, payment promptness, payor-member issues, and physician-payor relations. Works closely with other Finance teams to ensure reported data is reliable. Plans and organizes activities for personnel to ensure deadlines and goals are met. Supervises and trains staff to improve and maintain the accuracy and timeliness of contacts.

Overview

The Director, Managed Care Contracting is responsible for utilizing business and industry expertise, accepts responsibility for all activities in the Managed Care department applying to and impacting WakeMed facilities' managed care contracts including: budgeting, analysis, contract modeling, negotiation meetings and monitoring and reporting of payor contracts' compliance. Directs organizations efforts at building relationships with area managed care plans. Directly manages and develops a portfolio of managed care contracts. Directs contracting strategy for hospitals, HealthPlexes, hospital outpatient departments, Home Health and Rehab divisions. Develops payment models for facility managed care contracts. Oversees facility what-if modeling analysis performed in STRATA modeling tool. Oversees the following noncontracting Managed Care responsibilities: hospital contract loading in EPIC, hospital payment variances, facility credentialing. Works with CFO, Vice President of Finance, Finance Directors and financial analysts to analyze feasibility of different payment methodologies/utilization patterns and the impact on WakeMed. Monitors market trends and competitive managed care products to develop strategy recommendations. Works with WakeMed's accountable care organization to coordinate contracting efforts and outcomes beneficial to WakeMed providers. When requested, interfaces with external and third party auditors; prepares and defends contract questions and challenges; maintains quality of work and creates value through knowledge and experience with governmental regulations and processes. Adheres to service and workforce excellence by maintaining knowledge of third-party regulations (CMS, NCDHHS, DOI, etc.) for all payors, including governmental and commercial payors. Oversees problem solving related to contract terms, payment promptness, payor-member issues, and physician-payor relations. Works closely with other Finance teams to ensure reported data is reliable. Plans and organizes activities for personnel to ensure deadlines and goals are met. Supervises and trains staff to improve and maintain the accuracy and timeliness of contacts.

Department Description

Serving the community since 1961, WakeMed Health & Hospitals is the leading provider of health services in Wake County. With a mission to improve the health and well-being of our community, we are committed to providing outstanding and compassionate care. For more information, visit www.wakemed.org.

EOE

Licensure

Certified Healthcare Financial Professional Or Certified Public Accountant Or Certified Revenue Cycle Representative Preferred

Education

Bachelor's Degree Business Administration Or Healthcare Management Or Accounting Required - With College Courses Finance Required - And Master's Degree Related Field Preferred

Experience

10 Years Managed Care Contracting Required - And 5 Years Healthcare - Multi-Hospital System Preferred