Healthcare Strategy Manager – VBR

EPIC Health System • Southfield, MI

6d • Onsite

About The Position

EPIC Health is seeking a strategic, results-driven Healthcare Strategy Manager to lead initiatives that improve value-based reimbursement, payer performance, and financial and clinical outcomes. The role partners with executive leadership, Finance, Operations, Clinical Leadership, Revenue Cycle, Credentialing, and external payer and vendor partners. It translates payer contracts, quality metrics, financial data, and operational performance into actionable strategies, combining analysis, payer negotiation, relationship management, and execution.

The manager develops strategies to maximize value-based reimbursement; analyzes payer, financial, utilization, and quality performance; supports ACO and other value-based programs; and coordinates cross-functional efforts to improve patient outcomes while managing cost and utilization. The role also oversees provider credentialing and payer enrollment processes, vendors, performance reporting, regulatory awareness, and strategic project delivery. The position is based in Southfield, Michigan, and reports to Executive Leadership. Background checks are required.

Requirements

• Bachelor's degree in Healthcare Administration, Business Administration, Finance, Public Health, or a related field.
• At least 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.
• Background check required.

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 or 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 improvement opportunities.
• 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 reimbursement and performance metrics, communicate findings to leadership, and support forecasting and financial modeling.
• Build and maintain 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.
• Serve as an internal point of contact for payer-related issues and escalations; partner with Revenue Cycle and Finance to ensure contractual terms are implemented and monitored accurately.
• 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.
• Track program requirements, deadlines, deliverables, and performance targets; identify performance gaps and coordinate corrective strategies.
• Monitor HEDIS and other payer quality measures that affect reimbursement and value-based performance.
• Partner with Quality, Population Health, Clinical Operations, and providers to improve quality measure performance and address care gaps.
• Oversee provider credentialing and payer enrollment with internal teams and external vendors; monitor vendor timeliness, accuracy, and accountability.
• Monitor provider enrollment, recredentialing, revalidation, and payer participation; ensure new providers are credentialed and enrolled before providing billable services.
• Identify and resolve credentialing or enrollment issues that could affect provider participation or reimbursement, and maintain visibility into timelines and outstanding requirements.
• Analyze financial, operational, quality, utilization, and payer performance data; develop dashboards, reports, and presentations for executive leadership.
• Translate complex data into recommendations; monitor trends and identify risks and opportunities across contracts and value-based programs.
• Support financial forecasting and scenario analysis for reimbursement arrangements.
• Maintain knowledge of federal and state healthcare regulations affecting payer contracts, value-based reimbursement, ACOs, and provider enrollment.
• Ensure initiatives comply with applicable regulatory requirements; monitor industry and regulatory changes and communicate potential business impacts.
• Partner with Compliance, Legal, Finance, and Operations on contractual or regulatory issues.
• Lead strategic projects across departments and external partners; develop 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, drive projects through completion, and 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