Payment Innovations Lead

State of North Carolina•Wake Forest, NC

7d•$67,122 - $117,465•Hybrid

About The Position

This position serves as the program owner for NC Medicaid Population Health value-based payment (VBP) and Healthy Opportunities (HO) initiatives—driving execution of VBP and HO requirements and improving outcomes across health plan delivery systems. Responsibilities span HOP wind down management (currently paused due to lack of state funding), ongoing HRSN screening oversight across Standard Plans, Tailored Plans, and CFSP, and VBP program performance aligned with DHB’s Quality Strategy. This position includes responsibilities related to leading the wind down of Healthy Opportunities Pilots (HOP) and codifying lessons learned for integration into Medicaid operations. Health related social needs (HRSN) screening expectations across Standard, Tailored, and CFSP plans to support better data exchange and reduce duplicative screens. Collaboration with the Rural Health Transformation Program (RHTP) and sharing HO experience on closed loop referrals and Food Is Medicine approaches.

Requirements

Bachelor's degree from an appropriately accredited institution and five (5) years of progressive experience related to the area of assignment; or an equivalent combination of training and experience.

Nice To Haves

Strong working knowledge of North Carolina’s Medicaid Managed Care program or other Medicaid Managed Care programs
Experience with HRSN/SDOH initiatives, including screening, closed loop referrals, and program evaluation
Proven ability to propose and implement statewide strategies to address complex systems changes
Proven ability to analyze program data and information concerning program operations to evaluate effectiveness
Proven ability to effectively prioritize and organize work, set clear objectives, and break large-scale projects down to milestone deliverables or outcomes

Responsibilities

Serve as the program owner for NC Medicaid Population Health value-based payment (VBP) and Healthy Opportunities (HO) initiatives.
Drive execution of VBP and HO requirements and improve outcomes across health plan delivery systems.
Manage the wind down of Healthy Opportunities Pilots (HOP) and codify lessons learned for integration into Medicaid operations.
Oversee HRSN screening across Standard Plans, Tailored Plans, and CFSP.
Ensure VBP program performance aligns with DHB’s Quality Strategy.
Support better data exchange and reduce duplicative screens for HRSN screening.
Collaborate with the Rural Health Transformation Program (RHTP).
Share HO experience on closed loop referrals and Food Is Medicine approaches.