Managed Care Provider Relations Manager jobs in Raleigh, NC

ECU Health

About ECU Health

ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations.

The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Children's Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University. ECU Health and the Brody School of Medicine share a combined academic mission to improve the health and well-being of eastern North Carolina through patient care, education and research.

Position Summary

Provides strategic leadership, financial and administrative oversight of managed care contracting with commercial payors on behalf of ECU Health and their other companies. Executes all tasks and behaves in a manner consistent with a culture of safety and a high reliability; behavior supports the organization's core commitments ensuring professional relationships are maintained.

Responsibilities

The Director of Managed Care Contracting reports to the VP of Managed Care and is a key member of the ECU Health Managed Care team which oversees the contractual, operational and analytics responsibilities.

The position works collaboratively with system and regional leadership to develop and execute system payer and network development strategy related to third party commercial and managed government (Medicare Advantage and Managed Medicaid) managed care payment and facilitates enhanced access to the organization for members of the community.

The Director of Managed Care Contracting leads key Tier 1 payer negotiations and oversees Tier 2 negotiations with the goal of growing the payer portfolio and advancing the system's preferred pricing/reimbursement logic.

Also, this role is responsible for developing, integrating and aligning payer strategy with ECU Health's enterprise and service line strategic objectives, including population health strategies, fee-for-service and value-based contracting, contract management, operations processes, and government reimbursement trends.

The position will be responsible for establishing a standardized contracting process that ensures ensuring the enterprise follows all best practices for conducting comprehensive contracting life cycle (pre-negotiation, negotiation, and post-negotiation) activities.

The Director of Managed Care Contracting will supervise all Contracting Specialists and manage contracting processes for transplant services, high-tech services (gene therapy) and single case agreements.

The role will work closely with the Director of Managed Care Operations, Director of Managed Care Analytics, Revenue Cycle, Revenue Integrity, Legal, Finance, Pharmacy, and at the direction of the VP of Managed Care, to set payer and contracting strategies that optimizes ECU Health's revenue opportunities in support of the organization's Mission, Vision, and strategic objectives.

Minimum Requirements

Bachelor's degree required - Accounting, Business Administration, Finance, or Health related field required.

Master's degree preferred - Accounting, Business Administration, Finance, or Health related field.

5 years or greater of actual Managed Care experience from hospitals, insurance companies, consulting firms, or a related field required.

General Statement

It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant's qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.