Director, Managed Care Contracting

WakeMed Health & Hospitals•Raleigh, NC

17h

About The Position

The Director, Managed Care Contracting is responsible for activities in the Managed Care department that apply to and affect WakeMed facilities’ managed care contracts. The role directs contracting strategy for hospitals, HealthPlexes, hospital outpatient departments, Home Health, and Rehab divisions; builds relationships with area managed care plans; and directly manages and develops a portfolio of managed care contracts. Responsibilities include budgeting, analysis, contract modeling, negotiation meetings, and monitoring and reporting payor contract compliance. The Director develops facility payment models and oversees what-if modeling analysis using the STRATA modeling tool. The position also oversees hospital contract loading in EPIC, hospital payment variances, and facility credentialing. Working with finance leaders and analysts, the Director evaluates the feasibility and impact of payment methodologies and utilization patterns. The role monitors market trends and competitive managed care products, recommends strategies, and coordinates contracting efforts and outcomes with WakeMed’s accountable care organization. When requested, the Director interfaces with external and third-party auditors, prepares and defends contract questions and challenges, and maintains work quality while applying knowledge of governmental regulations and processes. The position maintains knowledge of third-party regulations, including CMS, NCDHHS, and DOI requirements, across governmental and commercial payors. It oversees problem solving related to contract terms, payment promptness, payor-member issues, and physician-payor relations, and works with Finance teams to ensure reported data is reliable. The Director plans and organizes personnel activities to meet deadlines and goals, and supervises and trains staff to improve and maintain the accuracy and timeliness of contracts. WakeMed Health & Hospitals has served the community since 1961 and describes its mission as improving the health and well-being of the community through outstanding and compassionate care.

Requirements

Bachelor’s degree in Business Administration, Healthcare Management, or Accounting required.
College coursework in Finance required.
10 years of managed care contracting experience required.

Nice To Haves

Master’s degree in a related field preferred.
Certified Healthcare Financial Professional, Certified Public Accountant, or Certified Revenue Cycle Representative preferred.
Five years of healthcare experience in a multi-hospital system preferred.

Responsibilities

Direct Managed Care department activities related to WakeMed facilities’ managed care contracts, including budgeting, analysis, contract modeling, negotiation meetings, and monitoring and reporting contract compliance.
Build relationships with area managed care plans and directly manage and develop a portfolio of managed care contracts.
Direct contracting strategy for hospitals, HealthPlexes, hospital outpatient departments, Home Health, and Rehab divisions.
Develop payment models for facility managed care contracts and oversee facility what-if modeling analysis using the STRATA modeling tool.
Oversee hospital contract loading in EPIC, hospital payment variances, and facility credentialing.
Work with finance leaders and analysts to analyze the feasibility of payment methodologies and utilization patterns and their impact on WakeMed.
Monitor market trends and competitive managed care products and develop strategy recommendations.
Coordinate contracting efforts and outcomes with WakeMed’s accountable care organization.
Interface with external and third-party auditors when requested; prepare and defend contract questions and challenges.
Maintain knowledge of third-party regulations for governmental and commercial payors, including CMS, NCDHHS, and DOI requirements.
Oversee problem solving related to contract terms, payment promptness, payor-member issues, and physician-payor relations.
Work with other Finance teams to ensure reported data is reliable.
Plan and organize personnel activities to ensure deadlines and goals are met.
Supervise and train staff to improve and maintain the accuracy and timeliness of contracts.