Primary Care Capitation Strategy & Finance Lead

Human Services Planner/Evaluator III (NS)

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!

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.

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

Salary Grade Range: $63,927.00 - $

Recruitment Range: $63,927.00 - $

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

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.

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

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.

In accordance with the…