Managed Care Contracts Director

Description

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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.

• 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…