Senior Manager of Managed Care Payer Analytics (Hybrid)

Job Summary

The Senior Manager of Managed Care Payer Analytics at UCLA Health is responsible for advancing the organization's managed care contracting strategy through expert financial analysis, contract modeling, and advisory support.

About the Role

This role evaluates complex commercial and government payer arrangements including Accountable Care Organizations, Centers of Excellence agreements, Medicare Advantage, Medi-Cal, hospital, medical group, and ambulatory contracts.

Responsibilities

• Develop and maintain advanced financial models to evaluate complex contract pricing, risk-sharing provisions, projected utilization, and reimbursement methodologies across commercial, Medicare, and Medi-Cal agreements.

• Lead EPIC CareConnect contract modeling functions, applying data warehouse tools including EPSi and Tableau to validate assumptions, resolve discrepancies, and ensure modeling integrity.

• Analyze payer agreements to identify revenue opportunities, assess policy and rate changes, evaluate financial risk, and recommend contract structure improvements.

• Monitor contract performance trends, review reimbursement accuracy, and provide data-driven insights to support negotiation strategy and long-range planning.

• Audit shared-risk program performance, prepare ACO analyses, and fulfill recurring and ad hoc managed care reporting requests.

• Advises on complex contract terms, chargemaster considerations, service line financial impacts, and regulatory or privacy implications.

• Collaborates cross-functionally with Finance, Revenue Cycle, Decision Support, and operational leaders to support forecasting, budgeting, and revenue optimization initiatives.

Qualifications

• A bachelor’s degree in a related field or equivalent combination of education and experience (required)

• A minimum of eight years of related experience in hospital and medical group financial analysis or managed care contracting (required)

• An advanced degree such as MBA or MPH (preferred)

• Professional certifications such as HFMA CRCR, CPHQ, or coding credentials including CCS or CPC (preferred)

• Advanced knowledge of managed care contracting principles, reimbursement methodologies, and rate structures (required)

• Strong proficiency with EPIC CareConnect and financial modeling platforms such as EPSi and Tableau (required)

• In-depth understanding of ICD-10 CM/PCS, HCPCS, CPT, and MS-DRG coding frameworks as they relate to reimbursement analysis (required)

• Expertise interpreting commercial HMO/PPO, Medicare, and Medi-Cal reimbursement mechanisms (required)

• Advanced analytical and financial modeling skills with strong attention to detail (required)

• Prioritizes proven ability to lead complex projects independently and communicate insights effectively to executive and cross-functional stakeholders (required)