Value-Based Healthcare Strategy Lead

Epic Health; Southfield (MI); On-site; USD 90,000 - 130,000; Full time

Benefits offered by this job

Medical, dental, and vision benefits

Disability and life insurance

401(k) retirement plan

Paid time off and holidays

Professional development and career成长

Job summary

EPIC Health in Southfield, MI is seeking a Healthcare Strategy Manager – Value-Based Reimbursement & Payer Strategy to lead initiatives that improve value-based reimbursement, payer performance, and financial/clinical outcomes.

This role partners with executive leadership, Finance, Operations, and Revenue Cycle to translate payer contracts and quality metrics into actionable strategies and drive execution across departments.

Qualifications

• Bachelor's degree in Healthcare Administration, Business Administration, Finance, Public Health, or related field.
• 5+ years of healthcare experience in value-based reimbursement, payer relations, healthcare strategy, ACO management, managed care, or related area.
• Demonstrated experience with payer contract analysis and/or negotiation.
• Strong understanding of value-based reimbursement models and healthcare payer operations.
• 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 and initiatives 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 financial provisions.
• Identify opportunities to improve reimbursement and strengthen payer relationships.
• Serve as a key internal point of contact for payer-related issues and escalations.
• Partner with Revenue Cycle and Finance to ensure contractual terms are accurately implemented and monitored.
• Monitor quality, utilization, financial, and patient outcomes in ACO/value-based programs.
• Collaborate with leaders to develop initiatives that improve patient outcomes while controlling costs.
• Track program requirements, deadlines, deliverables, and performance targets.
• Identify performance gaps and coordinate corrective strategies across departments.
• Monitor HEDIS and other payer quality measures that impact reimbursement.
• Provide dashboards/reports for leadership and translate data into actionable strategies.
• Stay current on regulatory changes affecting payer contracts and value-based initiatives.

Skills

Project management

Cross-functional leadership

Negotiation

Communication

Data analysis

Presentation skills

Relationship management

Analytical problem solving

Education

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

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

Job description

EPIC Health in Southfield, MI is seeking a Healthcare Strategy Manager – Value-Based Reimbursement & Payer Strategy to lead initiatives that improve value-based reimbursement, payer performance, and financial/clinical outcomes.

This role partners with executive leadership, Finance, Operations, and Revenue Cycle to translate payer contracts and quality metrics into actionable strategies and drive execution across departments.