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!

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

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 - $111,871.00

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

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

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.

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.

Minimum Education and Experience

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

Veterans’ and National Guard Preference

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

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.

Background Check Requirements

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.

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.