Director, Managed Care Contracting

WakeMed Health & Hospitals; Raleigh (NC); On-site; USD 95,000 - 130,000; Full time

Job summary

WakeMed Health & Hospitals in Raleigh, NC, is seeking a Director of Managed Care Contracting responsible for overseeing all activities impacting managed care contracts. This role includes budgeting, analysis, negotiation, and relationship management with payors. Candidates should have at least 10 years of experience in managed care contracting and preferably a background in a multi-hospital system. A Bachelor's degree in Business Administration or Healthcare Management is required, along with a Master's preferred. The position emphasizes compliance and strategic improvements.

Qualifications

• 10 years of experience in Managed Care Contracting required.
• 5 years experience in a Healthcare Multi-Hospital System preferred.
• Certified Healthcare Financial Professional or Certified Public Accountant or Certified Revenue Cycle Representative preferred.

Responsibilities

• Utilize business expertise to manage Managed Care department activities.
• Direct organizational efforts building relationships with managed care plans.
• Develop payment models for facility managed care contracts.
• Monitor market trends and develop strategy recommendations.

Skills

Business and industry expertise

Contract negotiation

Budgeting and analysis

Relationship building

Knowledge of governmental regulations

Education

Bachelor's Degree in Business Administration or Healthcare Management or Accounting

Master's Degree in Related Field

Tools

STRATA modeling tool

EPIC

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 organizational 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, www.wakemed.org.

EOE

Licensure

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

Education

Bachelor's Degree in Business Administration or Healthcare Management or Accounting Required – With College Courses in Finance Required – And Master's Degree in Related Field Preferred

Experience

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