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Director, Managed Care Contracting

Raleigh, NC · On-site

$95 - $130/hr

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 ...

WakeMed

Director, Managed Care Contracting

Raleigh, NC · On-site

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 ...

Pennant Services

Managed Care Contracting Manager

JOB SUMMARY The Managed Care Resource will support our Home Health, Hospice, Private Duty and Senior Living Facility leaders in managed care contracting and revenue enhancement strategies for all ...

Pennant Services

Managed Care Contracting Manager

JOB SUMMARY The Managed Care Resource will support our Home Health, Hospice, Private Duty and Senior Living Facility leaders in managed care contracting and revenue enhancement strategies for all ...

HENRY MAYO NEWHALL MEMORIAL HOSPITAL

Job Summary The Director of Managed Care Contracting provides strategic leadership for the hospital's payor contracting and Revenue Integrity functions; driving initiatives that optimize ...

International Executive Service Corps

$150 - $190/hr

Job Summary The Director of Managed Care Contracting provides strategic leadership for the hospital's payor contracting and Revenue Integrity functions; driving initiatives that optimize ...

New

NCH

Managed Care Contracting Analyst

Naples, FL · On-site

JOB SUMMARY The Managed Care Contracting Analyst is responsible for managing the contracting for all governmental and third party payer contracts to include provider enrollment, credentialing, data ...

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Director, Managed Care Contracting

Direct Jobs

Raleigh, NC • On-site

$95 - $130/hr

Other

This job post has expired today. Applications are no longer accepted.

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

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