Manager, Total Cost of Care

Healthfirst; Layton (UT); On-site; USD 89,000 - 132,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision coverage

401k contributions

Incentive programs

Recognition programs

Job summary

Healthfirst is seeking a Manager, Total Cost of Care to monitor financial performance and provide analytic insights across all Healthfirst products. You will serve as the healthcare economics and analytics expert, leading a team and collaborating with Finance, Claims, and Network to optimize reimbursement and cost trends.

The role requires extensive experience in managed care analytics, SAS/SQL, Tableau or Python, and strong communication skills to drive strategic decisions in a fast-paced

Qualifications

• Bachelor’s degree from an accredited institution is required.
• At least 6 years of healthcare analytics experience with 3+ years in contract evaluation or medical economics.
• Strong knowledge of managed care metrics and reimbursement methodologies.
• Experience with healthcare claims data and large data sets.
• Proficient in SAS or SQL and advanced Excel skills.

Responsibilities

• Monitor medical cost and utilization trends, provide actionable insights and root-cause analyses.
• Develop savings analyses for medical economics cost-trend reduction initiatives using financial models.
• Prioritize cost-mitigation activities across business areas and support decision making.
• Provide data-driven analysis to Finance, Claims, Pharmacy, Payment Integrity, Medical Management, Network, and other departments.
• Optimize reimbursement terms and coding across agreements; identify outliers.
• Assess and standardize contractual terms across provider agreements.
• Lead cross-functional efforts to resolve payment integrity issues.
• Develop tools and processes for operational and reimbursement management of hospitals and physician partners.
• Develop interactive financial models to evaluate provider reimbursement changes.
• Support provider settlements and data reconciliation activities.
• Create profitability dashboards by product.

Skills

Healthcare analytics

SAS/SQL

Excel

Leadership

Communication

Problem solving

Project management

Education

Bachelor's degree

Tools

Tableau

Python

Job description

The Manager, Total Cost of Care, will monitor financial performance and provide analytic insights into all products offered within the Healthfirst portfolio. This leader will serve as healthcare economics and analytics subject matter expert, across all areas of medical trend, medical cost savings, provider network informatics, and reimbursement accuracy. The ideal candidate will come from a managed care, medical economics, insurance, actuarial, or hospital background, and will be a results-oriented individual who enjoys working in a fast-paced and challenging environment.

Scope of Responsibilities:

• Monitor medical cost and utilization trends, provide concise actionable insight into the root cause drivers, and develop potential remediation opportunities.
• Develop savings analyses for Medical Economics cost trend reduction initiatives, applying financial modeling expertise and using independent judgement to determine best valuation methods.
• Prioritization of cost mitigation activities across business areas.
• Provide actionable data driven analysis to Finance, Claims, Pharmacy, Payment Integrity, Medical Management, Network, and other departments to enable critical decision making.
• Optimize contractual reimbursement terms and coding across agreements, systematically identifying reimbursement outliers.
• Assess and work with Network to standardize contractual terms and language across all provider agreements.
• Evaluate data to identify and root cause of payment integrity issues and lead cross-functional efforts to problem solve.
• Lead development of tools and processes for efficient operational and reimbursement management of hospitals and physician partners, including unit cost projections.
• Develop interactive financial models to evaluate the impact of provider reimbursement changes.
• Support all provider settlement and data reconciliation activities.
• Development of tools to define profitability dashboards by product.
• Keep abreast of New York Medicaid and Medicare reforms, reimbursement methodologies, and their impact on Healthfirst and their owner hospital performance.
• Individual contributor subject matter expert and/or managerial responsibilities.
• Perform ad hoc analyses.

Minimum Qualifications:

Bachelor’s Degree from an accredited institution. At least six (6) years of healthcare analytics experience, with at least three (3) years of experience in contract evaluation, medical economics, medical cost containment, actuarial , healthcare reimbursement model design Extensive knowledge of managed care financial metrics (PMPM, util/k, cost/unit). Experience utilizing healthcare claims data to uncover valuable insights to improve financial performance. Experience with Government and proprietary payor reimbursement methodologies and unit cost management. Experience with SAS or SQL (creates queries and manipulation of data). Extensive experience with Microsoft Excel (building financial models, utilizing pivot tables, vlookups, index match, and calculated fields). Claims experience including root-cause analysis, system set-up, etc Ability to work with large data sets. Strong written and verbal communication skills. Experienced in leading a team of analysts. Resourceful and creative in solving complex issues and working corroboratively with others on a solution. Ability to manage projects and project plans within stated timelines.

Preferred Qualifications:

Expertise in key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG’s), Ambulatory Patient Groups (APG’s), Ambulatory Payment Classifications (APC’s), and other payment mechanisms. Understanding of value-based risk arrangements. Experience using Tableau, Python Experience mentoring other team members.

Equal Opportunity Employer Statement:

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to [e-mail] or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied.

Hiring Range and Compensation:

Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $103,400 - $149,430 All Other Locations (within approved locations): $88,700 - $131,920 As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

• In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements).

Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. *The hiring range is defined as the lowest and highest salaries that Healthfirst in "good faith" would pay to a new hire, or for a job promotion, or transfer into this role. Healthfirst is New York’s largest not-for-profit health insurer offering it’s nearly 1.7 million members access to high-quality, affordable healthcare. As part of the community for nearly 30 years, Healthfirst’s unique advantage is rooted in its belief that good health doesn’t start in a doctor’s office. The company’s mission is to put its members first by working closely with care providers and community leaders to address broader issues that can impact health and well‑being. This value-based care model is the foundation of the company’s sustained growth in one of the most dynamic markets in the country. So, if you are passionate about what you do and want to work for a company that is focused on the future and dedicated to making a difference in people’s lives, then Healthfirst is for you.