Value-Based Health Strategy Manager – Payer & VBR

EPIC Health; Southfield, Northern (MI, KY); Hybrid; USD 90,000 - 150,000; Full time

Benefits offered by this job

Competitive pay

Medical, dental, and vision benefits

401(k) retirement plan

Paid time off

Professional development

Job summary

EPIC Health is seeking a Healthcare Strategy Manager to lead value-based reimbursement and payer strategy initiatives in Southfield, MI. This role partners with executive leadership, Finance, Operations, and external payer partners to optimize reimbursement models and financial outcomes.

The ideal candidate brings 5+ years in healthcare strategy, strong negotiation and data analysis skills, and a track record in managing credentialing and payer relationships.

Qualifications

• Bachelor's degree required in healthcare or related field.
• 5+ years of healthcare experience in value-based reimbursement, payer relations, or related areas.
• Demonstrated experience with payer contract analysis and/or negotiation.
• Strong understanding of value-based reimbursement models and 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 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 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.
• 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 provisions.
• Identify opportunities to improve reimbursement and strengthen payer relationships.
• Serve as internal point of contact for payer-related issues and escalations.
• Partner with Revenue Cycle and Finance to ensure terms are implemented and monitored.
• Support strategic management and performance of ACO and other value-based programs.
• Monitor quality, utilization, financial, and patient outcomes associated with value-based contracts.
• Collaborate with leaders to 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.
• Monitor HEDIS and other payer quality measures impacting reimbursement.

Skills

Negotiation

Communication

Presentation

Relationship management

Education

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

Job description

EPIC Health is seeking a Healthcare Strategy Manager to lead value-based reimbursement and payer strategy initiatives in Southfield, MI. This role partners with executive leadership, Finance, Operations, and external payer partners to optimize reimbursement models and financial outcomes.

The ideal candidate brings 5+ years in healthcare strategy, strong negotiation and data analysis skills, and a track record in managing credentialing and payer relationships.