Manager, Managed Care Analytics

Job Overview: Analytical Functions: The Manager, Managed Care Analytics plans, directs, and assumes accountability for Managed Care analytic functions. This includes a wide array of analytics related to payer performance and contracting impacts. The role involves managing the internal Managed Care analytics team and overseeing payer reimbursement modeling and data analytic support for TriHealth Managed Care Contracting functions. The Manager, Managed Care Analytics transforms claims and clinical data into actionable reports, designs and performs contract modeling, and develops contract performance dashboards. This role also supports contract negotiations and actively manages financial components of active contracts. The Manager, Managed Care Analytics evaluates and provides key input into the determination of financial strategy for payer proposals in conjunction with Managed Care leadership. This includes evaluating viability factors for service lines and potential expansion of programs and health plan products. The role involves fostering partnering relationships with key stakeholders, both internal and external to the organization. The Manager, Managed Care Analytics acts upon daily and monthly revenue reports to identify and review variances and takes corrective action when needed. This role is a SME for Epic contract modeling and maintains Epic certification in this area. The Manager, Managed Care Analytics is an Epic knowledge resource for Managed Care analysts. Customer Service: The role involves delivering excellent customer service to internal and external stakeholders and upholding TriHealth's mission. Job Responsibilities: Develop dashboards and ad-hoc reporting with minimal guidance in Excel/Tableau/PowerPoint; Perform complex data analysis and contract modeling support of ad-hoc, management, or executive requests; Collaborate with cross-functional teams, including clinical, technical, and finance teams; Validate data extracts and analyze any data variances; Conduct service line managed care reimbursement analysis as requested by Management; The Manager, Managed Care Analytics works in conjunction with applicable teams to develop reimbursement models and validate model(s), monitor variances, take corrective action as needed. This role identifies and integrates data from multiple sources and builds reimbursement models, dashboards, and reports within various platforms. The Manager, Managed Care Analytics performs statistical analysis of data extracted from various internal sources and prepares reports based on findings. This role proactively identifies data trends and outliers and provides suggestions to the causes, remedies, or process improvements in compliance with payment regulation and market guidance. Requirements: Bachelor's degree in finance, economics, statistics, mathematics, IT/IS, business administration, public health, or related field; Equivalent experience accepted in lieu of degree; Driver's License; 4-5 years of experience in management finance, economics, mathematics, statistics, IT/IS, business administration, health administration, public health, or related field; 2-3 years of experience in professional business; The Manager, Managed Care Analytics has the ability to mentor and develop direct reports. Working knowledge of healthcare reimbursement mechanisms, including hospital, ancillary, and physician payment systems, is critical in this role. This role requires thinking critically and with a high level of common sense. Strong customer service orientation, with the ability to partner effectively with individuals at all levels of the organization, is necessary. Exceptional verbal and written communication skills are required for this role. Ability to manage multiple priorities in a fast-paced environment is essential. The Manager, Managed Care Analytics must have working knowledge of billing and claims payment procedures and be able to think critically and with a high level of common sense.

Created: 2025-03-04