Healthcare Strategy Manager - VBR & Payer Stategy

Job Description

Job Description

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. 

Credentialing & Payer Enrollment

• 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, ora related field.

• 5+ years of healthcare experience in value-based reimbursement, payer relations, healthcare strategy, ACO management, managed care, ora 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