Primary Care Capitation Strategy & Finance Lead

Agency

Division

Job Classification Title

Human Services Planner/Evaluator III (NS)

Position Number

Grade

NC18

About Us

North Carolina State Government is one of the state’s largest employers, with over 76,000 employees all working toward a common goal: a safer and stronger North Carolina. We are a large organization comprised of various agencies, offices, and universities, each providing important public services.

Eligible state employees are entitled to comprehensive benefits, including a variety of leave options, professional development opportunities, insurance, and more. To learn more about the benefits of being a North Carolina state employee, visit the N.C. Office of State Human Resources' website.

Permanent, temporary, and time-limited state government jobs can be found from the mountains to the coast. Find your next opportunity today!

Description of Work

The Primary Care Capitation Strategy & Finance Lead serves as the integrated lead for federal authority alignment and payment strategy for the RHTP Primary Care Capitation Pilot and related value-based payment initiatives. The Lead translates policy strategy into operational financing, oversees directed payment submissions (as applicable), and coordinates per-member-per-month modeling and cost trending with actuarial partners. The role partners closely with collaborating internal DHB business units, prepaid health plans, and external stakeholders to ensure compliant, timely, and sustainable payment operations that align with broader Medicaid transformation.

Knowledge Skills and Abilities/Management Preferences

Salary Grade Range: $63,927.00 - $111,871.00

Recruitment Range: $63,927.00 - $104,175.00

Candidates now meet the minimum qualifications of a position if they meet the minimum education and experience listed on the vacancy announcement.

The Knowledge, Skills, and Abilities (KSAs)/ Management Preferences are not required. Applicants who possess the following skills are preferred:

• Demonstrated experience with cost modeling and forecasting in a health care setting
• Knowledge of health care provider payment and reimbursement methodologies with a focus on capitation and sub-capitation; demonstrated experience in value-based payment reform preferred
• Proficiency in Microsoft Excel; experience with SAS, R, Stata or other analytic/statistical software preferred
• Knowledge of CMS Medicaid managed care regulations, including the development, submission, and CMS preprint approval process for state-directed payment arrangements (e.g., minimum fee schedules, value-based payments)
• Familiarity with federal Medicaid finance policy and compliance frameworks

The Posting Will Close At 11:59 P.M. The Night Before The End Date

The Position Is Time-Limited

This Position Is 100% Federally Funded

This Role Is Eligible To Be Hybrid

About the Rural Health Transformation Program

NC Rural Health Transformation Program is a statewide program led by NCDHHS to transform rural health care delivery, improve health outcomes, and ensure sustainable access to care for nearly 3 million rural North Carolinians. The program is funded over five years by the Centers for Medicare & Medicaid Services (CMS).

The main goals of the program are to:

• Catalyze innovative health care models for rural communities by changing the way providers work together to care for patients in rural NC.
• Transform the rural care experience, building community-based clinical, behavioral, and social supports close to home.
• Create a sustainable rural health delivery system through underlying systems changes in rural workforce pipelines and care team models, and rural provider financial models.

Compensation and Benefits The State of North Carolina offers excellent comprehensive benefits. Employees can participate in health insurance options, standard and supplemental retirement plans, and the NCFlex program (numerous high-quality, low-cost benefits on a pre-tax basis). Employees also receive paid vacation, sick, and community service leave. In addition, paid parental leave is available to eligible employees. Visit website for State Benefits

Supplemental Contact Information

The North Carolina Department of Health and Human Services (DHHS) is an Equal Opportunity Employer that embraces an Employment First philosophy, which consists of complying with all federal laws, state laws, and Executive Orders. We are committed to reviewing requests for reasonable accommodation at any time during the hiring process or while on the job. For more information about DHHS: https://www.ncdhhs.gov/.

DHHS uses the Merit-Based Recruitment and Selection Plan to fill positions subject to the State Human Resources Act with the most qualified individuals. Hiring salary will be based on relevant qualifications, internal equity, and budgetary considerations pertinent to the advertised position.

In accordance with the Governor’s Executive Order 303, our agency supports second-chance employment for individuals who were previously incarcerated or justice-involved. We invite all potential applicants to apply for positions for which they may be qualified.

Application Process Be sure to complete the application in its entirety. Resumes will not be accepted in lieu of completing this application.

• Information should be provided in the appropriate areas, to include the following: Education, including high school and all degrees obtained, Work Experience, and Certificates & Licenses. It is critical to our screening and salary determination process that applications contain comprehensive candidate information.
• Answers to Supplemental Questions are not a substitute for providing all relevant information within the body of your application. To receive credit for the supplemental questions, you must provide supporting information within the "Work Experience" section of the application to support your answers.
• If multiple applications are submitted to an individual posting, only the most recent application received prior to the closing date will be accepted. Applications must be submitted by 11:59 PM the night BEFORE the closing date.
• Applicants may be subject to a criminal background check. All candidates selected for positions considered "Positions of Trust" will be subject to a criminal background check.
• Due to the volume of applications received, we are unable to provide information regarding the status of your application over the phone. To check the status of your application, please log in to your account. Upon the closing date, applications are "Under Review" and will be screened by Human Resources for qualified applicants. The hiring process may take several weeks.
• Degrees must be received from appropriately accredited institutions. Transcripts and degree evaluations may be uploaded with your application. The State of North Carolina/Office of State Human Resources uses the National Association of Credential Evaluation Services (NACES) as a referral resource for applicants who need to have their credentials certified as equivalent.
• For a list of organizations that perform this specialized service, please visit the NACES membership website at https://www.naces.org/members.

Degree/College Credit Verification

Degrees must be received from appropriately accredited institutions. Transcripts, degree evaluations and cover letters may be uploaded with your application.

Veterans’ and National Guard Preference

• Applicants seeking Veteran's Preference must attach a DD-214 Member-4 Form (Certificate of Release or Discharge from Active Duty) to their applications.
• Applicants seeking National Guard Preference must attach an NGB 23A (RPAS), along with the state application, if they are a current member of the NC National Guard in good standing.
• Applicants who are former members of either the NC Army National Guard or the NC Air National Guard, with honorable discharge and six years of creditable service, must attach a copy of the DD 256 or NGB 22, along with the state application.

ADA Accommodations

Consistent with the Americans with Disabilities Act (ADA) and the Pregnant Workers Fairness Act (PWFA), DHHS is committed to the full inclusion of all qualified individuals. As part of this commitment, DHHS will ensure that people with disabilities, or known limitations covered by the PWFA, are provided with reasonable accommodation. If reasonable accommodation is needed to participate in the job application or interview process, please contact the person Substance Abuse Professional Practice Board, etc.) indicated below.

CONTACT INFORMATION:

If there are any questions about this posting, please contact Talent Acquisition at [email protected]. Resumes will not be accepted in lieu of completing this application.

Minimum Education and Experience

Some state job postings say you can qualify by an “equivalent combination of education and experience.” If that language appears below, then you may qualify through EITHER years of education OR years of directly related experience, OR a combination of both. See the Education and Experience Equivalency Guide for details.

Planner:

Master's degree in public or human service administration or human services programmatic field from an appropriately accredited institution, and three years of human service experience, two of which must have been in human services program planning

OR

Bachelor's degree from an appropriately accredited institution, and five years progressive administrative or consultative experience in a human service program, two of which must have been in human service program planning

OR

An equivalent combination of education and experience

Evaluator:

Master's degree in the field of psychology, sociology, or social work from an appropriately accredited institution, and three years of experience in research and evaluation, using statistical methodologies in human service programs

OR

Bachelor's degree from an appropriately accredited institution, and five years of experience in research, evaluation and statistical application in the human service field

OR

An equivalent combination of education and experience

EEO Statement

The State of North Carolina is an Equal Employment Opportunity Employer and dedicated to providing employees with a work environment free from all forms of unlawful employment discrimination, harassment, or retaliation. The state provides reasonable accommodation to employees and applicants with disabilities; known limitations related to pregnancy, childbirth, or related medical conditions; and for religious beliefs, observances, and practices.

Recruiter:

Dreisa Yvonne Johnson

Recruiter Email:

[email protected]