Healthcare Strategy Manager - VBR & Payer Stategy

Healthcare Strategy Manager – VBR & Payer Stategy Full Time Management Southfield, MI, US 8 days ago Requisition ID: 3230 Healthcare Strategy Manager – Value-Based Reimbursement & Payer Strategy Location: Southfield, MI Employment Type: Full-Time Reports To: Executive Leadership Drive Value-Based Healthcare Strategy at EPIC Health EPIC Health is seeking a strategic and results-driven Healthcare Strategy Manager – Value-Based Reimbursement & Payer Strategy to lead initiatives that improve value-based reimbursement, payer performance, and overall financial and clinical outcomes. This role will serve as a key partner to executive leadership, Finance, Operations, Clinical Leadership, Revenue Cycle, Credentialing, and external payer and vendor partners. The ideal candidate understands how healthcare reimbursement works beyond traditional fee-for-service and can translate payer contracts, quality metrics, financial data, and operational performance into actionable strategies. This is a highly collaborative role for someone who can analyze the numbers, negotiate with payers, manage relationships, and drive execution. What You’ll Do Value-Based Reimbursement Strategy 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. Payer Relations & Contract Negotiation 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. ACO & Value-Based Program Management Support the strategic management and performance of ACO and other value-based care programs. Monitor quality, utilization, financial, and patient outcomes associated with value-based contracts. Partner with clinical and operational leaders to develop initiatives that 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. Quality & HEDIS Performance Monitor HEDIS and other payer quality measures that impact reimbursement and value-based performance. Partner with Quality, Population Health, Clinical Operations, and providers to improve quality measure performance. Analyze care gaps, utilization trends, and patient populations to identify opportunities for improvement. Support development of initiatives designed to improve HEDIS scores, patient outcomes, and payer incentives. Stay current on changes to quality measures, payer requirements, and value-based performance methodologies. Oversee provider credentialing and payer enrollment processes in partnership with internal teams and external vendors. Manage credentialing and enrollment vendors, ensuring timely completion, accuracy, and accountability. Monitor provider enrollment status, recredentialing, revalidation, and payer participation. Ensure new providers are appropriately credentialed and enrolled prior to providing billable services. Identify and resolve credentialing or enrollment issues that could impact provider participation or reimbursement. Maintain visibility into credentialing and enrollment timelines, requirements, and outstanding items. Data Analysis & Reporting Analyze financial, operational, quality, utilization, and payer performance data. Develop dashboards, reports, and presentations for executive leadership. Translate complex data into clear recommendations and actionable strategies. Monitor trends and identify risks and opportunities across payer contracts and value-based programs. Support financial forecasting and scenario analysis for new and existing reimbursement arrangements. Compliance & Regulatory Strategy Maintain knowledge of federal and state healthcare regulations affecting payer contracts, value-based reimbursement, ACOs, and provider enrollment. Ensure payer and value-based initiatives are implemented in accordance with applicable regulatory requirements. Monitor industry and regulatory changes and communicate potential business impacts to leadership. Partner with Compliance, Legal, Finance, and Operations when addressing contractual or regulatory issues. Cross-Functional Leadership & Project Management Lead strategic projects involving multiple departments and external partners. Develop project plans, timelines, milestones, and accountability measures. Coordinate initiatives across Finance, Operations, Clinical Leadership, Quality, Population Health, Revenue Cycle, Credentialing, and IT. Identify barriers, manage competing priorities, and drive projects through completion. Present recommendations and performance updates to executive leadership. What You Bring Required Qualifications Bachelor's degree in Healthcare Administration , Business Administration, Finance, Public Health, or a related field. 5+ years of healthcare experience in value-based reimbursement, payer relations, healthcare strategy, ACO management, managed care, or a related area . Demonstrated experience with payer contract analysis and/or negotiation. Strong understanding of value-based reimbursement models and healthcare 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. Preferred Qualifications Master's degree in Healthcare Administration , Business, Finance, Public Health, or a related field. Experience with ACOs, Medicare Shared Savings Program (MSSP), Medicare Advantage, Medicaid, or other risk/value-based arrangements. Experience with payer incentive programs, quality bonuses, shared savings, capitation, or risk contracts. Experience in a multi-site or rapidly growing healthcare organization. Familiarity with healthcare analytics, financial modeling, and reporting platforms. Value-based reimbursement strategy Payer relations and contract negotiation ACO and managed care operations HEDIS and quality performance Provider credentialing and payer enrollment Financial and healthcare data analysis Strategic planning Project management Cross-functional leadership Negotiation and relationship management Regulatory and compliance awareness Strong executive communication Why Join EPIC Health? At EPIC Health, you’ll have the opportunity to directly influence how healthcare is delivered and reimbursed while helping build scalable strategies for a rapidly growing organization. What We Offer Competitive compensation Comprehensive Medical, Dental, and Vision benefits Disability and Life Insurance 401(k) Retirement Plan Paid Time Off and Holiday Pay Professional development and career growth opportunities Opportunity to directly impact organizational growth, financial performance, and patient outcomes Ready to Drive Value-Based Healthcare Forward? Background checks are required for this role. #J-18808-Ljbffr EPIC Health