Total Cost of Care, Manager

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

Benefits offered by this job

Medical, dental and vision coverage

401k contributions

Incentive and recognition programs

Job summary

Healthfirst is seeking a Manager, Total Cost of Care, to drive analytics across the Healthfirst portfolio. The role focuses on healthcare economics, medical cost containment, provider network informatics, and reimbursement accuracy with a strong emphasis on cross-functional impact.

The candidate will lead data-driven cost and utilization analyses, build interactive financial models, and guide decision-making for Finance, Claims, Pharmacy, and Network teams.

Qualifications

• Bachelor’s degree from an accredited institution.
• Hybrid work schedule requiring in-office presence at 100 Church Street, NYC on Tue–Thu.
• At least six years in healthcare analytics, with three in contract evaluation, medical economics, or reimbursement model design.

Responsibilities

• Monitor medical cost and utilization trends and provide actionable insights.
• Develop savings analyses and financial models for cost trend reduction initiatives.
• Prioritize cost mitigation activities across business areas.
• Provide data-driven analysis to Finance, Claims, Pharmacy, and Network teams to support decisions.
• Optimize reimbursement terms and standardize provider agreement language.
• Identify reimbursement outliers and assess payer methodologies.
• Lead development of tools for hospital and provider reimbursement management.
• Develop profitability dashboards by product.
• Stay updated on Medicaid/Medicare reforms and their impact.

Skills

Healthcare analytics

Contract evaluation

Medical economics

Actuarial

Healthcare reimbursement

Leadership

Project management

Data analysis

Excel

Communication

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.

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.
• Must be able to work a hybrid work schedule consisting of reporting to our 100 Church Street, NYC office on Tuesdays, Wednesdays & Thursdays.
• 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.

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.