Manager, Total Cost of Care

HF Management Services•New York, NY

About The Position

The Manager, Total Cost of Care monitors financial performance and provides analytic insights across products in the Healthfirst portfolio. This role serves as a healthcare economics and analytics subject matter expert across medical trend, medical cost savings, provider network informatics, and reimbursement accuracy. The position may include individual-contributor subject matter expertise and/or managerial responsibilities, and performs ad hoc analyses. The role develops actionable, data-driven insights and financial models to support cost mitigation, reimbursement management, provider contracting, payment integrity, and business decision-making. It works across Finance, Claims, Pharmacy, Payment Integrity, Medical Management, Network, and other departments, and keeps abreast of New York Medicaid and Medicare reforms, reimbursement methodologies, and their impact on Healthfirst and owner hospital performance. The hiring range is $103,400–$149,430 for residents of the Greater New York City Area (NY, NJ, CT), and $88,700–$131,920 for other approved locations. Salary and related compensation depend on work experience, education, licenses, certifications, and other pertinent factors. Healthfirst offers medical, dental, and vision coverage, incentive and recognition programs, life insurance, and 401(k) contributions, subject to eligibility requirements.

Requirements

Bachelor’s degree from an accredited institution.
At least six years of healthcare analytics experience.
At least three years of experience in contract evaluation, medical economics, medical cost containment, actuarial work, or healthcare reimbursement model design.
Extensive knowledge of managed care financial metrics, including PMPM, utilization per thousand, and cost per unit.
Experience using healthcare claims data to uncover insights that improve financial performance.
Experience with government and proprietary payer reimbursement methodologies and unit cost management.
Experience with SAS or SQL, including creating queries and manipulating data.
Extensive Microsoft Excel experience, including building financial models and using pivot tables, VLOOKUPs, INDEX MATCH, and calculated fields.
Claims experience, including root-cause analysis and system setup.
Ability to work with large data sets.
Strong written and verbal communication skills.
Experience leading a team of analysts.
Resourcefulness and creativity in solving complex issues and collaborating with others on solutions.
Ability to manage projects and project plans within stated timelines.

Nice To Haves

Expertise in managed care concepts and provider reimbursement principles, including risk adjustment, capitation, fee-for-service, DRGs, APGs, APCs, and other payment mechanisms.
Understanding of value-based risk arrangements.
Experience using Tableau and Python.
Experience mentoring other team members.

Responsibilities

Monitor medical cost and utilization trends, identify root-cause drivers, and develop potential remediation opportunities.
Develop savings analyses for Medical Economics cost trend reduction initiatives, using financial modeling expertise and independent judgment to determine valuation methods.
Prioritize cost mitigation activities across business areas.
Provide actionable, data-driven analysis to Finance, Claims, Pharmacy, Payment Integrity, Medical Management, Network, and other departments to support critical decisions.
Optimize contractual reimbursement terms and coding across agreements and systematically identify reimbursement outliers.
Work with Network to assess and standardize contractual terms and language across provider agreements.
Evaluate data to identify and determine the root causes of payment integrity issues, and lead cross-functional problem-solving efforts.
Lead development of tools and processes for efficient operational and reimbursement management of hospital and physician partners, including unit cost projections.
Develop interactive financial models to evaluate the impact of provider reimbursement changes.
Support provider settlement and data reconciliation activities.
Develop tools to define profitability dashboards by product.
Keep abreast of New York Medicaid and Medicare reforms and reimbursement methodologies, and assess their impact on Healthfirst and owner hospital performance.
Perform ad hoc analyses.
Lead a team of analysts, as applicable to the role’s managerial responsibilities.