Healthcare Strategy Manager – VBR & Payer Stategy

EPIC Health System • Southfield, MI

10d • Onsite

About The Position

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.

Requirements

• 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.

Nice To Haves

• 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 managing credentialing/enrollment vendors.
• Experience in a multi-site or rapidly growing healthcare organization.
• Familiarity with healthcare analytics, financial modeling, and reporting platforms.

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.
• 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.
• 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.
• 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.
• 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.
• 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.

Benefits

• 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
• Collaborative, mission-driven environment
• Opportunity to directly impact organizational growth, financial performance, and patient outcomes

What This Job Offers

• Job Type: Full-time
• Career Level: Manager