Managed Care Operations Lead -Managed Care Contracting

Job Description

About WakeMed:
Serving the community since 1961, WakeMed Health & Hospitals is a nationally recognized, private, not-for-profit health care organization founded and based in Raleigh, N.C. The largest health system in Wake County, WakeMed exists to improve the health and well-being of our community by providing outstanding, compassionate, patient- and family-centered care to all. The 919-bed system comprises a network of facilities throughout the Triangle area, delivering health and wellness services that bring added value to the communities we serve. WakeMed is a leader in cardiac and vascular care, women’s and children’s services, emergency medicine and trauma care, physical rehabilitation, orthopaedics and neurosciences. Specialty facilities include the WakeMed Heart Center, Children’s Hospital, Women’s Pavilion and Birthplace, Rehabilitation Hospital, Adult and Children’s Emergency Departments and a Level 1 Trauma Center. WakeMed’s team of more than 9,400 employees, 2,000 volunteers, 1,300 affiliated physicians, and the more than 300 physicians employed by WakeMed Physician Practices use the most advanced technologies along with the best minds and the biggest hearts to ensure the finest quality in health care and community health. For more information, visit www.wakemed.org.

As an Equal Opportunity Employer, WakeMed provides an inclusive work environment that
promotes the valuing of differences, respect for people and cooperativeness among our diverse
workforce. WakeMed does not discriminate against any employee or applicant in any terms or
conditions of employment. All applicants/employees are considered for employment, transfer,
promotion or training without regard to race, religion, color, gender, gender identity/expression,
genetics, sexual orientation, age, pregnancy, national origin, disability or veteran status.

Position Information:
The Managed Care Operations Lead serves as a resource and advisor directs all aspects of managed care operations including system wide credentialing with managed care plans contract performance monitoring and reporting and contract payment modeling and analysis.  Works in collaboration  with Chief Financial Officer consultants Vice President of Finance Director and Managed Care Specialists to recommend contracting strategies perform complex contract modeling and to monitor health plan performance.  Acts as a liaison between Managed Care Contracting Reimbursement Patient Financial Services Patient Access and other departments in the hospital in an effort to create seamless operational performance and reimbursement maximization related to managed care contracting and performance monitoring.

Experience Requirements:
10 Years Managed Care Contracting Required - With 7 Years Managed Care Contracting In Healthcare Required

Education Required:
Bachelor's Degree Business Administration Or  Healthcare Or  Finance Or  Related Field Required - And Master's Degree Health Administration Or  Business Preferred

Licensure/Certification Requirements:
Not Applicable

Hours of Work:
Mon - Fri

Weekend Requirements:
No Weekends

Call Requirements:
None

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