Strategic Analytics Manager, Quality Reimbursement & Value-Based Care

Adventist HealthCare•Gaithersburg, MD

21h•$116,228 - $177,757•Hybrid

About The Position

Adventist HealthCare is seeking an experienced Strategic Analytics Manager for its Quality Reimbursement & Value-Based Care team. The Manager will serve as a subject-matter expert in Maryland hospital quality reimbursement, value-based payment, and strategic healthcare analytics. The role leads the replication, validation, interpretation, forecasting, and monitoring of HSCRC and CMS financial and quality payment models, using claims, financial, quality, utilization, and total-cost-of-care data. It applies risk adjustment, grouping, statistical, benchmarking, and payment-policy methods to assess organizational performance and turn complex regulatory and reimbursement requirements into actionable insights. The position has particular responsibility for HSCRC quality methodologies and supports analytics under CMS quality programs and the AHEAD Model. It works closely with Quality, Population Health, Care Management, Finance, Clinical Operations, and other stakeholders to connect quality performance, utilization, reimbursement, and organizational strategy. The Strategic Analytics team uses a portfolio model, so the Manager may also lead or contribute to analytics initiatives beyond the core quality, population health, and value-based care portfolio. The Manager develops and maintains models, forecasts, scenarios, dashboards, scorecards, reporting tools, and analytical controls for HSCRC and CMS programs, including QBR, RRIP, MHAC, PAU, HVBP, HRRP, HACRP, and AHEAD-related adjustments. The role monitors regulatory and payment-policy developments, documents methodologies and assumptions, reconciles model results against external benchmarks, and presents risks, opportunities, and recommendations to executive and operational leaders. It also leads complex analytics projects, partners across the organization, mentors analysts, supports standardized analytical practices, and provides internal education on payment methodologies and performance implications. This is a full-time, hybrid position. The listed pay range is $116,227.90–$177,756.80. Adventist HealthCare describes itself as a faith-based organization and states that it strongly recommends COVID-19 vaccination before employment; applicants may be required to provide proof. The organization will not hire applicants who report nicotine use or test positive for nicotine or drug use, including marijuana. Adventist HealthCare is an Equal Opportunity/Affirmative Action Employer and states that it will make reasonable accommodations for applicants with disabilities and, where applicable, religious beliefs.

Requirements

Bachelor’s degree in finance, economics, healthcare administration, public health, data analytics, statistics, business administration, or a related quantitative or healthcare field.
Seven or more years of progressive experience in healthcare analytics, reimbursement, payment policy, decision support, medical economics, or a related field.
Demonstrated expertise in Maryland’s HSCRC environment, including hands-on experience replicating, validating, interpreting, or forecasting HSCRC financial and/or quality payment methodologies, with particular depth in quality reimbursement.
Demonstrated experience developing or replicating complex healthcare reimbursement, quality, or value-based payment models.
Strong understanding of Maryland’s hospital global budget framework, Total Cost of Care principles, and quality/value-based payment programs.
Experience analyzing HSCRC case-mix data and other large healthcare claims, financial, quality, utilization, or operational datasets.
Demonstrated knowledge and application of risk adjustment methodologies, grouping or attribution methods, statistical approaches, benchmarking techniques, measure specifications, scoring methodologies, and performance target setting.
Ability to integrate and analyze claims, financial, quality, utilization, and total-cost-of-care data to evaluate organizational performance and identify actionable opportunities.
Demonstrated ability to translate complex payment policy and analytical findings into clear, actionable recommendations for executive, clinical, financial, and operational audiences.
Advanced proficiency with SQL, Excel, and data visualization/business intelligence tools such as Power BI or Tableau.
Strong critical thinking, quantitative analysis, problem-solving, project management, and written and verbal communication skills.
Demonstrated leadership of complex analytics projects and teams, including experience coaching or developing analysts and managing multiple priorities and deliverables.
Demonstrated ability to rapidly learn, interpret, replicate, and operationalize new reimbursement and quality methodologies as state and federal payment models evolve.

Nice To Haves

Master’s degree in healthcare administration, public health, business administration, finance, economics, data science, statistics, or a related field.
Three or more years of direct people-management experience or comparable leadership of complex analytical teams and portfolios.
Experience replicating or analyzing CMS hospital financial or quality payment methodologies, including HVBP, HRRP, HACRP, or related national value-based payment programs.
Knowledge of the CMS/CMMI AHEAD Model and its implications for Maryland hospital global budgets, quality performance, total cost of care, and value-based care.
Experience with Medicare claims or beneficiary-level data, including CCLF and/or CCW data.
Experience working with CRISP data and reporting services.
Experience in population health, medical economics, actuarial informatics, predictive analytics, or value-based care analytics.
Experience with advanced statistical analysis and tools such as Python, R, SAS, or comparable platforms.

Responsibilities

Serve as a subject-matter expert on HSCRC quality reimbursement methodologies, Maryland’s hospital global budget environment, CMS quality programs, and the interaction of state and federal payment models.
Replicate, validate, maintain, and forecast HSCRC and CMS financial and quality policy models in line with published methodologies, technical specifications, and regulatory guidance.
Interpret and operationalize HSCRC, CMS/CMMI, CRISP, and other relevant regulatory guidance, payment methodologies, technical specifications, and reporting requirements.
Apply risk adjustment, grouping and attribution methods, statistical techniques, benchmarking, measure specifications, scoring methods, and performance thresholds to evaluate performance and reimbursement exposure.
Analyze claims, financial, quality, utilization, clinical, and total-cost-of-care data to identify performance drivers, risks, and opportunities.
Translate payment policy, regulatory guidance, and analytical findings into actionable financial, clinical, and operational insights for leaders.
Develop and maintain analytical methodologies for HSCRC QBR, RRIP, MHAC, PAU and successor methodologies, CMS HVBP, HRRP, HACRP, AHEAD-related adjustments, and other applicable value-based payment programs.
Monitor emerging state and federal reimbursement policies and assess their potential organizational financial and operational impacts.
Document methodologies, assumptions, data sources, calculation logic, validation processes, and analytical controls.
Develop financial models and perform scenario analysis, sensitivity modeling, forecasting, and performance-driver analysis for quality performance, policy changes, utilization trends, population health outcomes, and operational initiatives.
Reconcile internal model results against regulatory, payer, or external benchmarks and investigate material variances.
Identify clinical, operational, utilization, population, and financial factors driving performance and reimbursement outcomes; develop projections to support planning and resource prioritization.
Apply appropriate economic, statistical, benchmarking, and healthcare measurement methods to evaluate organizational performance.
Present reimbursement analyses, policy implications, risks, opportunities, and strategic recommendations to executive and operational leadership.
Design and maintain enterprise analytics, dashboards, scorecards, and performance-management tools related to quality reimbursement, population health, total cost of care, and value-based care.
Monitor HSCRC and CMS quality payment performance, AHEAD-related measures and adjustments, population health and disparities measures, and other strategic quality KPIs.
Integrate HSCRC case-mix, CRISP, Medicare claims and beneficiary-level, financial, reimbursement, quality, clinical, utilization, population health, and total-cost-of-care data to assess performance and patient outcomes.
Establish data validation, reconciliation, and quality-control processes to ensure reliable and reproducible analytics.
Develop scalable analytical solutions using SQL, Power BI, Excel, Tableau, and other enterprise analytics platforms.
Lead complex enterprise analytics projects from problem definition and methodology development through implementation, communication, and performance monitoring.
Partner with Quality, Population Health, Care Management, Finance, Clinical Operations, and other leaders to identify opportunities and develop evidence-based performance strategies.
Lead and mentor analysts and team members, setting standards for analytical quality, methodology replication, documentation, project management, and timely delivery.
Support standardized analytical processes, databases, reporting tools, and methodologies across the organization.
Represent Adventist HealthCare, as appropriate, in external regulatory, policy, and industry forums and workgroups, including those involving HSCRC, the Maryland Hospital Association, CMS/CMMI, and CRISP.
Educate and train internal stakeholders on quality payment methodologies, regulatory changes, analytical interpretation, and performance implications.
Contribute to analytics initiatives outside the primary quality reimbursement portfolio based on organizational priorities and team needs.
Apply strategic, financial, operational, statistical, and data analytics capabilities to emerging enterprise questions and cross-functional initiatives.
Promote analytical consistency, knowledge sharing, and collaboration across subject-matter areas.

Benefits

Medical, prescription, dental, and vision coverage for employees and eligible dependents effective on date of hire.
Employer-paid short- and long-term disability, basic life insurance, and AD&D; short-term disability buy-up available.
Paid Time Off.
Employer retirement contribution and match after one year of eligible employment, with a three-year vesting period.
Voluntary benefits including flexible spending accounts, legal plans, and life, pet, auto, home, long-term care, and critical illness and accident insurance.
Subsidized childcare at participating childcare centers.
Tuition reimbursement.
Employee Assistance Program support.
Free employee parking.
Work-life balance through nonrotating shifts.
Recognition and rewards for professional expertise.