Value Based Care specialist

Community Care Plan; Town of Florida (NY); Hybrid; USD 90,000 - 120,000; Full time

Job summary

Community Care Plan seeks a Value-Based Healthcare Performance Analyst to support the Medical Economics department. The role analyzes claims, encounters, and membership data to improve provider performance, population health outcomes, and cost efficiency across Medicaid and Marketplace products.

The analyst will develop dashboards and analytical insights, collaborate with clinical, operational, and provider relations teams, and ensure data accuracy for impactful decision-making in a managed care

Qualifications

• Bachelor’s degree in Health Informatics, Healthcare Administration, Public Health, Economics, Data Analytics, or related field
• Minimum of 3 years of healthcare analytics or population health experience
• Strong proficiency in SQL and Excel; familiarity with healthcare data analysis tools
• Experience with healthcare claims, encounter, membership data in healthcare or payer settings

Responsibilities

• Analyze claims, encounter, and membership data to identify trends in provider performance and population health outcomes
• Develop and maintain provider performance reporting, dashboards, and insights for value-based initiatives
• Evaluate population health trends, disease burden, and risk indicators affecting outcomes and financial performance
• Prepare provider-level performance reports and healthcare performance summaries for internal operations
• Support monitoring of value-based payment arrangements through analysis of quality, utilization, and financial metrics
• Collaborate with analytics, clinical, operational, and provider relations teams to translate data into actionable insights
• Maintain data accuracy and quality through validation and QA practices
• Assist in developing reporting tools for healthcare operations and provider performance monitoring

Skills

SQL

Excel

Healthcare data analytics

Provider performance analytics

Education

Bachelor's degree in Health Informatics / related field

Tools

-

Job description

The Value-Based Healthcare Performance Analyst supports the Medical Economics department through healthcare performance analysis and reporting focused on provider performance, population health trends, and value-based program outcomes across Community Care Plan products, including Medicaid and Marketplace. This role analyzes healthcare claims, encounter, and membership data to identify opportunities for improved provider performance, healthcare utilization, documentation accuracy, and population health outcomes. The analyst develops reporting and performance insights that support value-based healthcare initiatives, population health strategies, and organizational decision-making within a managed care environment. The position collaborates with analytics, clinical, operational, and provider relations teams to translate complex healthcare data into actionable insights that support healthcare quality improvement and provider performance initiatives. This role is ideal for professionals with experience in value-based healthcare, provider performance analytics, or population risk analysis within a healthcare or managed care setting.

Qualifications

Required:

• Bachelor’s degree in Health Informatics, Healthcare Administration, Public Health, Economics, Data Analytics, or a related healthcare or analytical field
• Minimum of 3 years of experience supporting healthcare analytics, healthcare performance reporting, or population health initiatives within a healthcare or managed care environment
• Strong proficiency in SQL, Excel, and healthcare data analysis tools used to support reporting, performance monitoring, and operational insights
• Experience working with healthcare claims, encounter, membership, or clinical datasets within a healthcare, payer, or population health setting

Preferred:

• Experience working with Medicaid and/or ACA Marketplace health plan data
• Knowledge of Marketplace risk adjustment methodologies, population risk scoring models, or value-based healthcare performance measures
• Experience supporting value-based payment programs, provider performance initiatives, or population health strategies
• Experience developing provider performance reporting, dashboards, or healthcare performance analytics used to support operational and business decision-making

Essential Duties and Responsibilities

• Analyze healthcare claims, encounter, and membership data to identify trends related to healthcare utilization, provider performance, population health outcomes, and cost drivers across Medicaid and Marketplace populations.
• Develop and maintain provider performance reporting, dashboards, and analytical insights used to support value-based healthcare initiatives and population health strategies.
• Evaluate population health trends, disease burden, documentation patterns, and healthcare risk indicators that may impact healthcare outcomes and financial performance.
• Identify variations in provider performance and highlight opportunities for healthcare quality and operational improvement based on analysis of healthcare data.
• Prepare provider-level performance reports and healthcare performance summaries used to support internal business operations and healthcare performance monitoring.
• Support monitoring and evaluation of value-based payment arrangements by analyzing provider performance against defined quality, utilization, and financial metrics.
• Conduct ad hoc healthcare analyses to support Medical Economics initiatives, including evaluation of healthcare cost drivers, utilization trends, and population risk characteristics.
• Collaborate with analytics, clinical, operational, and provider relations teams to ensure accurate interpretation and communication of healthcare performance data.
• Maintain data accuracy and integrity through validation processes, quality assurance reviews, and ongoing monitoring of analytical outputs.
• Assist in the development of reporting and analytical tools that support healthcare operations, provider performance monitoring, and value-based care initiatives.

This job description in no way states or implies that these are the only duties performed by the employee occupying this position. Employees will be required to perform any other job-related duties assigned by their supervisor or management.

Skills and Abilities

• Strong analytical and quantitative skills
• Ability to interpret complex healthcare data and identify actionable insights
• Effective written and verbal communication skills
• Ability to present data clearly to technical and non-technical audiences
• Strong attention to detail and data validation practices
• Ability to manage multiple analytical projects simultaneously

Work Schedule

Community Care Plan is currently following a hybrid work schedule. The company reserves the right to change the work schedules based on the company needs.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit, use hands, reach with hands and arms, and talk or hear. The employee is frequently required to stand, walk, and sit. The employee may occasionally be required to stoop, kneel, crouch or crawl. The employee may occasionally lift and/or move up to 15 pounds.

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. The environment includes work inside/outside the office, travel to other offices, as well as domestic travel. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

We are an equal opportunity employer who recruits, employs, trains, compensates and promotes regardless of age, color, disability, ethnicity, family or marital status, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our employees unique. We are committed to fostering, cultivating, and preserving a culture of diversity, equity, and inclusion.

In compliance with Florida law, candidates selected for this position must complete a Level 2 background screening through the Florida Care Provider Background Screening Clearinghouse.

The Clearinghouse is a statewide system managed by the Agency for Health Care Administration (AHCA) and is designed to help protect children, seniors, and other vulnerable populations while streamlining the screening process for employers and applicants.