Sr Manager, Payor Performance Analytics

Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together. The Payor Performance Data Analytics Senior Manager serves as an analytical leader responsible for driving the financial, analytical, and operational components of Kelsey Seybold's payer contracting strategy. This role oversees complex reimbursement modeling and partners cross functionally to ensure successful contract negotiations and implementation of new agreements. The Payor Performance Data Analytics Senior Manager plays a critical role in shaping the organization's capitation and value based care portfolio, identifying opportunities for growth, and ensuring financial sustainability across all contract types. You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications Bachelor's degree or equivalent work experience 5+ years Health Care or Health Plan analytical experience Extensive experience with SQL servers, SAP, data management systems, including but not limited to Excel, Access, and Microsoft Data Services. Knowledge of CMS rules and regulations, Managed Care payment methodologies, and proficient in MS office products, and Power BI Experience working with claims and large healthcare datasets and solid understanding of payer financial models and cost structures Experience applying AI enabled analytics tools (e.g., automated insights, predictive modeling, and intelligent reporting features within platforms such as Power BI or SQL based environments) to support healthcare financial analysis and decision making. Healthcare knowledge with a strong understanding of Medicare Advantage Reimbursement and risk adjustment, capitation and value-based models. Understanding of: Provider reimbursement methodologies (e.g., % of Medicare, DRG, case rates) Preferred Qualifications EPIC Hands-on experience conducting cost and utilization analyses to identify actionable performance improvement opportunities within payer or value-based arrangements Experience working with SQL servers and diverse data management systems across different platforms Experience using a range of reporting and analytics tools beyond standard Microsoft Office, with the ability to adapt to different environments Experience leading health plan performance reporting, including cost, utilization, and benchmarking across Commercial, Medicare Advantage, and Marketplace products Experience managing financial reporting for value-based care programs, including shared savings and shared risk models, with responsibility for reconciling claims, capitation, and medical expense data Experience working with Risk Adjustment Factor (RAF) analytics and collaborating with health plans to improve Medicare Advantage performanceExperience presenting financial performance results and strategic insights in payer-facing settings, including Joint Operating Committee (JOC) meetings Working knowledge of payer financial models, reimbursement structures, and large healthcare datasets in practical applications Familiarity with healthcare data analysis without deep specialization in regulatory frameworks or advanced analytics tools Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 to $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. #J-18808-Ljbffr Optum