Director, Managed Care Contracting

WakeMed Health & Hospitals; Raleigh (NC); On-site; USD 180,000 - 280,000; Full time

Job summary

WakeMed Health & Hospitals in Raleigh, NC seeks a Director of Managed Care Contracting to lead contracting strategy across hospitals and outpatient services. The role oversees budgeting, contract modeling, negotiation meetings, and compliance monitoring with CMS and state payors.

You will manage a portfolio of contracts, develop payment models, supervise staff, and collaborate with CFO and finance teams to analyze feasibility of payment methodologies.

Qualifications

• Bachelor’s degree in Business Administration or Healthcare Management.
• 10 years of managed care contracting experience required.
• 5 years of healthcare experience in a multi-hospital system preferred.
• Certified Healthcare Financial Professional (CHFP) or Certified Public Accountant (CPA) helpful.

Responsibilities

• Lead contracting strategy for hospital and outpatient facilities.
• Manage budgeting, modeling, negotiations, and compliance monitoring.
• Develop payment models and analyze feasibility of methodologies.
• Supervise staff and coordinate with CFO/Finance teams.

Education

Bachelor's Degree Business Administration

Healthcare Management

Accounting Required - With College Courses Finance Required

Master's Degree Related Field Preferred

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.

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
• Certified Public Accountant
• Certified Revenue Cycle Representative Preferred

Education

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

Experience

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