Director, Managed Care Analytics

Enterprise leader for payer analytics, contract modeling, and contract performance optimization within a health care system. This role develops advanced financial, statistical, and predictive models to support managed care contracting strategy, value-based care performance, and revenue optimization, transforming traditional analytics into a modern, AI-enabled decision support function.

Responsibilities

• Develop advanced financial, statistical, and predictive models for managed care contracting strategy and value-based care performance.
• Leverage automation, machine learning, and advanced data platforms to deliver predictive, prescriptive, and real-time insights across the payer lifecycle.
• Partner with Patient Business Services, Revenue Integrity, Patient Access, Finance, Clinical Operations, and Information Technology to ensure data integrity and actionable insights.
• Serve as a strategic advisor to executive leadership on payer strategy, contract performance, reimbursement optimization, and value-based care initiatives.
• Guide AI governance and responsible use of data and analytics, ensuring transparency, regulatory compliance, and ethical use of artificial intelligence.
• Establish a scalable, enterprise-wide payer analytics framework integrating claims, clinical, and contract data.
• Enhance visibility into payer performance to enable proactive contract management and revenue optimization.
• Deploy AI-enabled workflows for contract performance monitoring, underpayment detection, and denial prevention.
• Strengthen strategic alignment between payer relations, revenue cycle operations, and clinical leadership through shared data infrastructure.

Requirements

• Bachelor's Degree in Finance, Healthcare Administration, Data Analytics, Statistics, or a related field (Master's degree preferred).
• 8+ years of progressive experience in healthcare analytics, decision support, or revenue cycle analytics.
• 3-5+ years in a leadership or management role.
• Demonstrated experience leading payer contract modeling and supporting negotiation strategy.
• Experience with value-based care and alternative payment models.
• Advanced proficiency in Excel, data modeling, and BI tools such as Tableau.
• Experience with healthcare data including claims, clinical records, and EHR data.
• Experience with contract modeling tools and systems.
• Working knowledge of AI applications in healthcare analytics and predictive modeling.
• Strong working knowledge of Medicare Advantage, Medicaid (including Texas programs), and commercial exchange products.
• Strong knowledge of reimbursement methodologies and contract structures.
• Familiarity with data integration challenges in healthcare.
• HFMA certification preferred.
• Epic Resolute expected reimbursement certification required.

Skills

• Epic contract modeling
• Strategic translation
• Systems thinking
• Executive communication
• Builder mindset

Benefits

• Medical, dental, and vision coverage
• Federal and state leave programs as required by applicable agency regulations (eligibility applies)