Healthcare Strategy Manager – VBR

Epic Health System Llc; Southfield (MI); On-site; USD 90,000 - 130,000; Full time

Benefits offered by this job

Medical benefits

Dental & Vision

401(k)

Paid time off

Job summary

EPIC Health is seeking a strategic Healthcare Strategy Manager to lead value-based reimbursement and payer strategy, partnering with executive leadership to improve financial and clinical outcomes.

The role requires deep knowledge of payer contracts, HEDIS, and cross-functional collaboration across finance, operations, and clinical leadership to drive performance and sustainable value.

Qualifications

• Bachelor's degree in Healthcare Administration, Business, Finance, Public Health, or a related field.
• 5+ years of healthcare experience in value-based reimbursement, payer relations, healthcare strategy, ACO management, or related areas.
• Demonstrated experience with payer contract analysis and/or negotiation.
• Strong understanding of value-based reimbursement models and healthcare payer operations.
• Experience analyzing healthcare financial, quality, and operational data.
• Experience with HEDIS measures and quality performance metrics.
• Experience managing or overseeing provider credentialing and payer enrollment.
• Strong project management and cross-functional leadership skills.
• Excellent negotiation, communication, presentation, and relationship-management skills.
• Strong analytical and problem-solving abilities.

Responsibilities

• Develop and implement value-based reimbursement strategies to maximize opportunities.
• Analyze payer performance, reimbursement models, utilization, quality, and financial results.
• Monitor performance against value-based contracts and develop improvement plans.
• Coordinate with clinical and operational teams to align workflows with payer requirements.
• Track reimbursement and performance metrics and report to leadership.
• Support forecasting and financial modeling related to value-based arrangements.
• Build and maintain relationships with commercial, Medicare, Medicaid, and other payers.
• Lead or support payer contract negotiations and renewals.
• Analyze contract terms, incentives, risk arrangements, and quality requirements.
• Identify opportunities to improve reimbursement and payer relationships.
• Coordinate credentialing and enrollment with internal teams and vendors.

Skills

Value-based strategy

Payer relations

Contract negotiation

Cross-functional leadership

Project management

Analytical thinking

Communication & presentation

Regulatory/regulatory awareness

Education

Bachelor's degree in Healthcare Administration, Business, Finance, Public Health or related field

Job description

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Healthcare Strategy Manager - VBR

Full Time Management Southfield, MI, US

Healthcare Strategy Manager - Value-Based Reimbursement & Payer Strategy

Location: Southfield, MI Employment Type: Full-Time Reports To: Executive Leadership

Drive Value-Based Healthcare Strategy at EPIC Health

EPIC Health is seeking a strategic and results-driven Healthcare Strategy Manager - Value-Based Reimbursement & Payer Strategy to lead initiatives that improve value-based reimbursement, payer performance, and overall financial and clinical outcomes.

This role will serve as a key partner to executive leadership, Finance, Operations, Clinical Leadership, Revenue Cycle, Credentialing, and external payer and vendor partners. The ideal candidate understands how healthcare reimbursement works beyond traditional fee-for-service and can translate payer contracts, quality metrics, financial data, and operational performance into actionable strategies.

This is a highly collaborative role for someone who can analyze the numbers, negotiate with payers, manage relationships, and drive execution.

What You'll Do

Value-Based Reimbursement Strategy

• Develop and implement strategies to maximize value-based reimbursement opportunities.
• Analyze payer performance, reimbursement models, utilization, quality, and financial results to identify opportunities for improvement.
• Monitor performance against value-based contracts and develop action plans to improve results.
• Partner with clinical and operational teams to align workflows and initiatives with payer requirements and financial goals.
• Track key reimbursement and performance metrics and communicate findings to leadership.
• Support forecasting and financial modeling related to value-based arrangements.

Payer Relations & Contract Negotiation

• Build and maintain strong relationships with commercial, Medicare, Medicaid, and other payer partners.
• Lead or support payer contract negotiations, renewals, amendments, and performance discussions.
• Analyze contract terms, reimbursement rates, incentives, risk arrangements, quality requirements, and other financial provisions.
• Identify opportunities to improve reimbursement and strengthen payer relationships.
• Serve as a key internal point of contact for payer-related issues and escalations.
• Partner with Revenue Cycle and Finance to ensure contractual terms are accurately implemented and monitored.

ACO & Value-Based Program Management

• Support the strategic management and performance of ACO and other value-based care programs.
• Monitor quality, utilization, financial, and patient outcomes associated with value-based contracts.
• Partner with clinical and operational leaders to develop initiatives that improve patient outcomes while managing cost and utilization.
• Track program requirements, deadlines, deliverables, and performance targets.
• Identify performance gaps and coordinate corrective strategies across departments.

Quality & HEDIS Performance

• Monitor HEDIS and other payer quality measures that impact reimbursement and value-based performance.
• Partner with Quality, Population Health, Clinical Operations, and providers to improve quality measure performance.
• Analyze care gaps, utilization trends, and patient populations to identify opportunities for improvement.
• Support development of initiatives designed to improve HEDIS scores, patient outcomes, and payer incentives.
• Stay current on changes to quality measures, payer requirements, and value-based performance methodologies.
• Oversee provider credentialing and payer enrollment processes in partnership with internal teams and external vendors.
• Manage credentialing and enrollment vendors, ensuring timely completion, accuracy, and accountability.
• Monitor provider enrollment status, recredentialing, revalidation, and payer participation.
• Ensure new providers are appropriately credentialed and enrolled prior to providing billable services.
• Identify and resolve credentialing or enrollment issues that could impact provider participation or reimbursement.
• Maintain visibility into credentialing and enrollment timelines, requirements, and outstanding items.

Data Analysis & Reporting

• Analyze financial, operational, quality, utilization, and payer performance data.
• Develop dashboards, reports, and presentations for executive leadership.
• Translate complex data into clear recommendations and actionable strategies.
• Monitor trends and identify risks and opportunities across payer contracts and value-based programs.
• Support financial forecasting and scenario analysis for new and existing reimbursement arrangements.

Compliance & Regulatory Strategy

• Maintain knowledge of federal and state healthcare regulations affecting payer contracts, value-based reimbursement, ACOs, and provider enrollment.
• Ensure payer and value-based initiatives are implemented in accordance with applicable regulatory requirements.
• Monitor industry and regulatory changes and communicate potential business impacts to leadership.
• Partner with Compliance, Legal, Finance, and Operations when addressing contractual or regulatory issues.

Cross-Functional Leadership & Project Management

• Lead strategic projects involving multiple departments and external partners.
• Develop project plans, timelines, milestones, and accountability measures.
• Coordinate initiatives across Finance, Operations, Clinical Leadership, Quality, Population Health, Revenue Cycle, Credentialing, and IT.
• Identify barriers, manage competing priorities, and drive projects through completion.
• Present recommendations and performance updates to executive leadership.

What You Bring

Required Qualifications

• Bachelor's degree in Healthcare Administration , Business Administration, Finance, Public Health, or a related field.
• 5+ years of healthcare experience in value-based reimbursement, payer relations, healthcare strategy, ACO management, managed care, or a related area .
• Demonstrated experience with payer contract analysis and/or negotiation.
• Strong understanding of value-based reimbursement models and healthcare payer operations.
• Experience analyzing healthcare financial, quality, and operational data.
• Experience with HEDIS measures and quality performance metrics .
• Experience managing or overseeing provider credentialing and payer enrollment.
• Strong project management and cross-functional leadership skills.
• Excellent negotiation, communication, presentation, and relationship-management skills.
• Strong analytical and problem-solving abilities.

Preferred Qualifications

• Master's degree in Healthcare Administration , Business, Finance, Public Health, or a related field.
• Experience with ACOs, Medicare Shared Savings Program (MSSP), Medicare Advantage, Medicaid, or other risk/value-based arrangements.
• Experience with payer incentive programs, quality bonuses, shared savings, capitation, or risk contracts.
• Experience in a multi-site or rapidly growing healthcare organization.
• Familiarity with healthcare analytics, financial modeling, and reporting platforms.
• Value-based reimbursement strategy
• Payer relations and contract negotiation
• ACO and managed care operations
• HEDIS and quality performance
• Provider credentialing and payer enrollment
• Financial and healthcare data analysis
• Strategic planning
• Project management
• Cross-functional leadership
• Negotiation and relationship management
• Regulatory and compliance awareness
• Strong executive communication

Why Join EPIC Health?

At EPIC Health, you'll have the opportunity to directly influence how healthcare is delivered and reimbursed while helping build scalable strategies for a rapidly growing organization.

What We Offer

• Competitive compensation
• Comprehensive Medical, Dental, and Vision benefits
• Disability and Life Insurance
• 401(k) Retirement Plan
• Paid Time Off and Holiday Pay
• Professional development and career growth opportunities
• Opportunity to directly impact organizational growth, financial performance, and patient outcomes

Ready to Drive Value-Based Healthcare Forward?

If you understand how to turn payer strategy, quality performance, and reimbursement data into measurable results , we want to hear from you.

Background checks are required for this role.