Manager, Total Cost of Care

Healthfirst; New York (NY); On-site; USD 103,000 - 149,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

401k contributions

Incentive programs

Life insurance

Job summary

Healthfirst is seeking a Manager, Total Cost of Care, to oversee financial performance and deliver analytic insights across the Healthfirst portfolio. The role serves as a healthcare economics and analytics SME, working across medical cost trends, reimbursement accuracy, and cost containment.

Onsite collaboration is required in New York City, with a hybrid schedule reporting to 100 Church Street on Tue–Thu.

Qualifications

• Bachelor’s degree from an accredited institution.
• Minimum 6 years of healthcare analytics with 3+ years in contract evaluation and medical economics.
• Strong knowledge of managed care metrics (PMPM, utilization, cost per unit).
• Experience using healthcare claims data to derive insights.
• Experience with government and payor reimbursement methods.
• Proficiency in SAS or SQL.
• Excel proficiency for financial models.
• Claims analysis and root-cause analysis.
• Experience handling large datasets.
• Strong communication skills.
• Experience leading teams.
• Problem-solving and collaboration.
• Project management experience.

Responsibilities

• Monitor medical cost and utilization trends and provide actionable insights.
• Develop savings analyses for cost trend reduction initiatives.
• Prioritize cost mitigation activities across business areas.
• Provide data-driven analyses to Finance, Claims, Pharmacy, and other departments.
• Optimize reimbursement terms and coding across provider agreements.
• Evaluate data to identify payment integrity issues and lead cross-functional efforts.
• Lead development of tools and processes for hospital and physician reimbursement management.
• Develop interactive financial models of provider reimbursement changes.
• Support provider settlement and data reconciliation activities.
• Stay updated on NY Medicaid/Medicare reforms and their impact.
• Individual contributor or managerial responsibilities.
• Perform ad hoc analyses.

Skills

Healthcare analytics

Contract evaluation

Medical economics

SAS/SQL

Excel modeling

Team leadership

Claims data analysis

Government payor methods

Big data handling

Education

Bachelor’s degree

Tools

SAS

SQL

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.

Hybrid Work Schedule

• This role will be onsite which consists of reporting to our 100 Church Street, New York, NY 10007 every Tuesday, Wednesday, and Thursday.

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.
• 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, VLOOKUP's, index match, and calculated fields).
• Claims experience including root-cause analysis, system set-up.
• 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.

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.