Managed Care Contracts Director

Description

Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve.

Description

Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve.

Summary

The HCS Director of Managed Care Contracting serves as one of the Health Care System’s top managed care executives responsible for strategy development, financial analysis, and contract negotiation of local, regional, and national strategic payer relationships. The position is one of the key members of UNC Health's managed care executive team, reporting to the System Vice President of Managed Care. All payer relationships that require contracting across our system are in the scope of responsibility for the position. Key areas of focus include assessment, negotiation, implementation, and management of: commercial fee-for-service and value-based managed care payer contracts; Medicare Advantage and Managed Medicaid managed care fee-for-service and value-based payer contracts; narrow network public and private exchange payer contracts; military (Tricare, VA) contracts; direct to employer contracts, specialty (such as transplant) and carve-out payer (such as behavioral health and vision) contracts, single case agreements, center of excellence designation programs, and other partnership opportunities with payers as required. The position is also a thought leader and organizational expert/consultant in support of system growth initiatives whether clinically, operationally, or otherwise with a primary role of informing how organizational initiatives will be received by payers and leading efforts to develop plants to execute such projects. The HCS Director of Managed Care Contracting will optimize the organization's contract performance with its contracted payers to maximize the organization’s financial viability while also advancing the system’s population health and value-based payment model strategies. This position will be the point person for a portfolio of payer contracts that include all of our system owned and managed entities, and each individual in this role will negotiate and manage a portfolio of payer contracts worth anywhere from $500 million to more than $2 billion dollars of annual payments to UNC Health.

Responsibilities

• Strategic - The HCS Director of Managed Care Contracting is a key part of the executive team that leads the development and implementation of system-wide Managed Care strategy. Leverages advanced analytics and AI-driven tools to enhance contract negotiations and modeling, predict negotiation outcomes, and assess policy impacts, ensuring data-informed strategies that optimize financial and operational performance. This requires working closely with senior leadership (primarily system level and entity specific CFOs, CEOs, and physician executives) at all entities while fostering effective working relationships with payers, employer groups, associations, and other internal and external stakeholders with the goal of working in alignment to generate industry leading outcomes. Engages in all aspects of contract negotiation and analysis pertaining to external payers (national/regional insurance carriers) on behalf of UNC Health’s owned and managed hospitals, professional groups, and ancillary business units including joint ventures such as ambulatory surgery centers. The position is part of a core executive team that evaluates and executes on opportunities that drive growth and profitability for UNC Health under both fee for service and value-based alternative payment concepts. The position is a strategic thought leader both internally and in the broader marketplace. Contributes to collaboration, integration, and performance improvement activities with legal, revenue cycle and clinical operations to achieve strategic, financial, and operational performance goals while also searching out and advocating for new tools and processes to drive greater ability to ensure the organization’s requirements are met in a timely and accurate manner.
• Operational – Each of the positions with the title of HCS Director of Managed Care Contracting will be responsible for leading day to day management of a portfolio of payer contracts representing $500 million to more than $2 billion in annual system revenue that could cover any part of the managed care spectrum (commercial, Medicare Advantage, Medicaid Managed Care, specialty and carve-out services, direct to employer, etc.) covering all of UNC Health’s owned and managed hospitals, physician groups, and ancillary services. This work includes helping to develop and overseeing monthly, quarterly, and annual management processes including but not limited to business reviews and strategy processes for Managed Care. This position will utilize AI-enabled platforms to centralize payer-provider agreements, automate extraction of key contract data, benchmark rates, and model financial impacts, while ensuring compliance with federal pricing transparency requirements and improving workflow efficiency. Managed Care related operational responsibilities include assurances that contractual rate increases happen on time and accurately for all entities, input and understanding of financial modeling for contract negotiations, creation and dissemination of payer performance data, support maintenance of contract builds in Epic, and negotiations including new agreements and amendments. The position would lead in the identification, analysis/quantification, and opposition to material adverse payer policy changes that cause negative impacts on UNC Health financial and operational outcomes. The position must also be skilled in developing, analyzing, and interpreting financial, operational, and strategic metrics to assist the System Chief Financial Officer, Chief Revenue Officer, System VP of Managed Care, Executive Director of Managed Care and other UNC Health executives with effective performance management and decision making in addition to supporting the ongoing growth of our system.
• Leading People - Leads people toward meeting the organization's vision, mission, and goals. Provides an inclusive workplace that fosters and mentors the development of others, facilitates cooperation and teamwork, and supports constructive resolution of conflicts. Encourages workforce engagement by building a commitment to excellence and by promoting the organization's vision internally and externally. Delegates’ responsibility clarifies expectations and holds others accountable for achieving results related to their area of responsibility. Leads in a deliberate and predictable way and operates with transparency. Treats sensitive or confidential information appropriately. Develops the ability of others to perform and contribute to the organization by providing ongoing feedback and by providing opportunities to learn through formal and informal methods. Manages and resolves conflicts and disagreements in a constructive manner.
• Leading Change - Acts as a catalyst for organizational change. Influences others to translate vision into action. Brings about strategic change, both within and outside the organization, to meet organizational goals. Establishes an organizational vision and implements it in a continuously changing environment. Is open to change, embraces new methodologies, and new information and rapidly adapts to new information, changing conditions, or unexpected obstacles. Deals effectively with pressure and remains optimistic and persistent, even under adversity. Recovers quickly from setbacks. Formulates objectives and priorities, and implements plans consistent with the long-term interests of the organization. Capitalizes on opportunities and manages risks. Takes a long-term view and builds a shared vision with others.
• Results Driven - Exceeds organizational goals and customer expectations. Makes decisions that produce high-quality results by applying technical knowledge, analyzing problems, and calculating risks. Holds self and others accountable for measurable high-quality, timely, and cost-effective results. Delivers high-quality services and is committed to continuous improvement. Fosters a culture of safe and compassionate patient care. Makes well-informed, timely decisions, even when data are limited or solutions produce unfavorable results. Positions the organization for success by identifying new opportunities and builds the organization by developing and improving services and processes.

Other Information

Other information:

Education Requirements

• Bachelor’s degree in business administration, health administration, or a related field.
• Master's degree in Health Administration (MHA) or Business Administration (MBA) focusing on healthcare or a related field preferred.

Professional Experience Requirements

• Requires at least 7 years of progressive experience in managed care contracting within a healthcare provider or payer organization. At least 5 years of leadership experience in a similar role.

Knowledge/Skills/and Abilities Requirements

• Deep understanding of various managed care models (HMO, PPO, EPO), their structures, reimbursement methodologies, and contracting principles.
• Proficiency in understanding financial modeling, contract profitability analysis, and forecasting the financial implications of different contract terms.
• Exceptional negotiation skills to secure favorable contract terms, reimbursement rates, and value-based incentives for the healthcare organization.
• Proficiency in Microsoft Office tools such as Word, Excel, PowerPoint, Outlook, Teams and One Note.
• Familiarity with AI-driven contract management systems and predictive analytic tools to support negotiation strategies and evaluate policy changes
• Strong analytical and communication skills (writing, presentations, etc.); ability to translate complex data into actionable insights.
• Aptitude for identifying potential contract issues, creatively developing solutions, and proactively addressing challenges.
• Capacity to develop a long-term managed care contracting strategy that aligns with the organization's goals and enhances its market position.
• Comfortable with navigating a dynamic healthcare environment, responding to regulatory changes, and adapting contracting approaches as needed.

Job Details

Legal Employer: NCHEALTH
Entity: Shared Services
Organization Unit: Managed Care
Work Type: Full Time
Standard Hours Per Week: 40.00
Pay offers are determined by experience and internal equity
Work Assignment Type: Hybrid
Work Schedule: Day Job
Location of Job: US:NC:Morrisville
Exempt From Overtime: Exempt: Yes
This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care; except that, if you are currently a UNCHCS State employee already working in a designated shared services department, you may remain a UNCHCS State employee if selected for this job.
Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.
UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities.
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