Value Based Care specialist

Position Summary

The Value-Based Healthcare Performance Analyst supports the Medical Economics department through healthcare performance analysis and reporting focused on provider performance, population health trends, and value-based program outcomes across Community Care Plan products, including Medicaid and Marketplace. This role analyzes healthcare claims, encounter, and membership data to identify opportunities for improved provider performance, healthcare utilization, documentation accuracy, and population health outcomes. The analyst develops reporting and performance insights that support value-based healthcare initiatives, population health strategies, and organizational decision-making within a managed care environment. The position collaborates with analytics, clinical, operational, and provider relations teams to translate complex healthcare data into actionable insights that support healthcare quality improvement and provider performance initiatives. This role is ideal for professionals with experience in value-based healthcare, provider performance analytics, or population risk analysis within a healthcare or managed care setting.

Qualifications

• Bachelor’s degree in Health Informatics, Healthcare Administration, Public Health, Economics, Data Analytics, or a related healthcare or analytical field
• Minimum of 3 years of experience supporting healthcare analytics, healthcare performance reporting, or population health initiatives within a healthcare or managed care environment
• Strong proficiency in SQL, Excel, and healthcare data analysis tools used to support reporting, performance monitoring, and operational insights
• Experience working with healthcare claims, encounter, membership, or clinical datasets within a healthcare, payer, or population health setting

Essential Duties and Responsibilities

• Analyze healthcare claims, encounter, and membership data to identify trends related to healthcare utilization, provider performance, population health outcomes, and cost drivers across Medicaid and Marketplace populations.
• Develop and maintain provider performance reporting, dashboards, and analytical insights used to support value-based healthcare initiatives and population health strategies.
• Evaluate population health trends, disease burden, documentation patterns, and healthcare risk indicators that may impact healthcare outcomes and financial performance.
• Identify variations in provider performance and highlight opportunities for healthcare quality and operational improvement based on analysis of healthcare data.
• Prepare provider-level performance reports and healthcare performance summaries used to support internal business operations and healthcare performance monitoring.
• Support monitoring and evaluation of value-based payment arrangements by analyzing provider performance against defined quality, utilization, and financial metrics.
• Conduct ad hoc healthcare analyses to support Medical Economics initiatives, including evaluation of healthcare cost drivers, utilization trends, and population risk characteristics.
• Collaborate with analytics, clinical, operational, and provider relations teams to ensure accurate interpretation and communication of healthcare performance data.
• Maintain data accuracy and integrity through validation processes, quality assurance reviews, and ongoing monitoring of analytical outputs.
• Aid in the development of reporting and analytical tools that support healthcare operations, provider performance monitoring, and value-based care initiatives.

Skills and Abilities

• Strong analytical and quantitative skills
• Ability to interpret complex healthcare data and identify actionable insights
• Effective written and verbal communication skills
• Ability to present data clearly to technical and non-technical audiences
• Strong attention to detail and data validation practices
• Ability to manage multiple analytical projects simultaneously

Work Schedule

Community Care Plan is currently following a hybrid work schedule. The company reserves the right to change the work schedules based on the company needs.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The environment includes work inside/outside the office, travel to other offices, as well as domestic travel. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. The environment includes work inside/outside the office, travel to other offices, as well as domestic travel. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.