The Managed Care Contracts Manager is a key position in UNC Health’s Managed Care Department and represents UNC Health’s owned and managed facilities, physician groups, and ancillary services in negotiations with payers. The position supports UNC Health’s goals of assuring patient access to our entities and financial stability of our system by leading negotiation and maintenance of high-performing contracts with managed care and other payers. The position is responsible for overseeing and developing a system-wide portfolio of payer relationships and associated initiatives and must work with stakeholders across the health system to ensure contractual and strategic goals are met. The position also must work collaboratively with other members of the Managed Care Department to ensure all contracts are appropriately identified, negotiated, implemented, audited and renegotiated in a timely manner.
Key responsibilities include:
- Identification of contracting opportunities that allow new and existing patients the ability to access UNC Health owned and managed entities on an “in network” basis with a variety of payers and product types including fee-for-service, risk, and other value-based agreements;
- Management of a portfolio of system wide and entity specific payer contracts that span multiple payer and entity types for our owned and managed entities;
- Development and maintenance of relationships with payers that to facilitate effective communication and problem solving regarding new and existing contracts and products;
- Review and negotiation of contract language to ensure compliance with internal guidelines, strategic priorities, legal requirements, and sound business practices;
- Consultation with clinical and business units across UNC Health to assess if contract terms and requirements are realistic and collaboration and leadership in development of acceptable alternatives;
- Review and analysis of relevant financial data to ensure consistency with strategic objectives and contract performance;
- Engagement and frequent communication with senior level finance and operational executives and other stakeholders across the health system to explain contracting initiatives, gain support for key objectives related to payer negotiations, and ensure buy in of important contracting decisions.
- Bachelors’ degree is required, and a Masters’ (MBA or MHA) is preferred.
- If a master's degree, requires three (3) years of experience in contract negotiation and/or managed care.
- Five years of experience working for either a health care system or a managed health care payer in a contracting or provider/payer relations position is ideal.
- Knowledge of the commercial and governmental managed health care industry, including fee-for-service, risk-based payment, and other value-based payment models is a must.
- Extensive familiarity with the health care industry and health system operations is highly desired.
- Microsoft office.