Job Description

The Managed Care Value-Based Expert provides subject-matter expertise and advanced analytical support for managed care contracting and value-based payment arrangements. The role leads complex financial modeling, proforma development, contract performance evaluation, and reconciliation activities across traditional and value-based payment models, informing negotiation strategy, contract compliance assessments, financial performance and enterprise decision-making in partnership with managed care leadership.

KEY RESPONSIBILITIES

You will:

• Prepare advanced reimbursement, financial impact, and performance analyses to support managed care contract negotiations and payer strategy.
• Design and evaluate value-based payment models, including shared savings, quality metrics, risk corridors, and attribution methodologies.
• Conduct pro forma and sensitivity analyses to estimate the financial value of proposed contract changes, cost containment initiatives, and industry trends.
• Conduct sensitivity analyses and stress testing on models to understand the range of potential outcomes under multiple utilization and cost scenarios.
• Monitor and analyze contract and value-based program performance, identify underpayments, compliance gaps, unfavorable payment trends, and financial risks.
• Develop monthly forecasts and financial packages summarizing value-based performance, payment reconciliation, and variance analysis.
• Conduct quarterly and annual reconciliation audits for value-based programs, ensuring payer compliance with contractual terms and identifying areas of non-compliance affecting contract performance.
• Develop and implement innovative tools and methodologies to monitor healthcare trends to accurately forecast value-based performance.
• Synthesize insights from payer data, market trends, and industry developments to inform negotiation strategy and enterprise decision-making.
• Create executive-ready visualizations for contract performance and financial forecasting tailored to different stakeholder audiences (clinical vs. financial). Build repeatable analytic processes that scale across programs.
• Mentor Managed Care Analysts, provide technical guidance, and contribute to analytical standards and process improvements within the team.

QUALIFICATIONS

• Bachelor’s degree in STEM field (eg. Economics, Actuarial Science, Health Economics, Business Administration, Finance, Accounting, Healthcare Administration, , or related discipline) or Master’s degree in Business Administration (MBA), Healthcare Administration (MHA), Public Health (MPH), Finance, or related field 
• 5-7+ years of progressive experience in healthcare finance, payer analytics, medical economics, or related healthcare consulting
• Demonstrated experience supporting value-based contract development, including performance measurement, attribution/quality metrics, reconciliation, and dispute resolution/appeals processes
• Experience with forecasting, audit, and predictive analytics to support negotiation and contract performance management
• Advanced proficiency in SQL, Tableau, and/or Power BI. Demonstrated experience extracting, validating, and analyzing large healthcare claims, reimbursement, and/or value-based performance datasets
• Certified Healthcare Financial Professional (CHFP) — Healthcare Financial Management Association (HFMA)
• Certified Professional in Healthcare Quality (CPHQ) — National Association for Healthcare Quality (NAHQ)

Location: BGC

Work Set-up: Hybrid | mid/night shift

Schedule: Monday to Friday