Primary Care Capitation Strategy & Finance Lead
About The Position
The Primary Care Capitation Strategy & Finance Lead serves as the integrated lead for federal authority alignment and payment strategy for the RHTP Primary Care Capitation Pilot and related value-based payment initiatives. The Lead translates policy strategy into operational financing, oversees directed payment submissions (as applicable), and coordinates per-member-per-month modeling and cost trending with actuarial partners. The role partners closely with collaborating internal DHB business units, prepaid health plans, and external stakeholders to ensure compliant, timely, and sustainable payment operations that align with broader Medicaid transformation.
Requirements
- Master's degree in public or human service administration or human services programmatic field from an appropriately accredited institution, and three years of human service experience, two of which must have been in human services program planning OR Bachelor's degree from an appropriately accredited institution, and five years progressive administrative or consultative experience in a human service program, two of which must have been in human service program planning OR An equivalent combination of education and experience
- Master's degree in the field of psychology, sociology, or social work from an appropriately accredited institution, and three years of experience in research and evaluation, using statistical methodologies in human service programs OR Bachelor's degree from an appropriately accredited institution, and five years of experience in research, evaluation and statistical application in the human service field OR An equivalent combination of education and experience
Nice To Haves
- Demonstrated experience with cost modeling and forecasting in a health care setting
- Knowledge of health care provider payment and reimbursement methodologies with a focus on capitation and sub-capitation; demonstrated experience in value-based payment reform preferred
- Proficiency in Microsoft Excel; experience with SAS, R, Stata or other analytic/statistical software preferred
- Knowledge of CMS Medicaid managed care regulations, including the development, submission, and CMS preprint approval process for state-directed payment arrangements (e.g., minimum fee schedules, value-based payments)
- Familiarity with federal Medicaid finance policy and compliance frameworks
Benefits
- health insurance options
- standard and supplemental retirement plans
- NCFlex program (numerous high-quality, low-cost benefits on a pre-tax basis)
- paid vacation
- sick leave
- community service leave
- paid parental leave
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
