Lead Analytics Manager - Value Based Care

The Lead Value-Based Care Analytics Manager oversees develop and leads presentation of advanced analysis for clinical, financial and operational performance leveraging healthcare claims, clinical, operational and related data sources. This role plays a critical part in evaluating and informing strategic decision-making across the enterprise, especially regarding value-based care and risk-based programs. This role requires expert knowledge of healthcare claims and claims analytics, clinical quality and quality metrics, clinical coding, care team operations and initiatives as well as analytics tools and techniques for the analysis of this data. This role supports other team members in their learning and development, works closely across the enterprise with key stakeholders, engages with CMS and national and regional payors, and regularly presents analysis, findings and recommendations to senior leaders. This role is part of our Value-Based Care Institute (VBCI) products and analytics team and works with minimal direct supervision.

Key Responsibilities

Data Analysis & Performance Monitoring

o Provide oversight and expert insight to the analysis of claims, clinical, and operational data to assess performance in value-based contracts.

o Ensure success in the reporting and monitoring of key performance indicators (KPIs) such as total cost of care, quality measures, risk scores, utilization, and shared savings metrics.

o Recommend and oversee the development, implementation and monitoring of reports and dashboards to track contract performance and identify opportunities for improvement.

Modeling & Financial Impact

o Support financial forecasting and impact modeling for value-based contracts and risk-based arrangements (including CMS and CMMI programs, Medicare Advantage, Medicaid, Commercial, Direct to Employer (D2E), and bundles (including CMS TEAM)).

o Contribute to budget planning, performance projections, and shared savings / loss calculations.

o Analyze benchmark methodologies, trend factors, and attribution logic to support negotiations and strategy.

Quality & Outcomes Analytics

o Measure and evaluate quality performance against HEDIS, STAR ratings, CMS quality programs, and custom metrics.

o Collaborate with clinical teams to identify gaps in care and improvement opportunities.

Contract & Program Support

o Provide analytic support for the design, implementation, and evaluation of new value-based arrangements.

o Interpret complex payer contract terms to translate into measurable analytic goals.

Cross-Functional Collaboration

o Work with senior leaders across the enterprise and care continuum to support value-based care analysis and performance improvement.

o Participate in system and network-wide workstreams providing the analytics and value-based care perspective

o Oversee the development of presentations, executive summaries, and board-level reporting on value-based care contracts, programs and initiatives.

EDUCATION : ? Formal training or work experience in data analytics, data analysis, or data science.

• ? Minimum of 10 years of experience. A bachelor?s degree is considered to meet 3 years of experience; a master?s degree is considered to meet an additional 1 year of experience, and a doctorate degree is considered to meet an additional 2 years of experience. Other relevant formal training in data analytics and / or healthcare analysis and operations may be considered on a case-by-case basis.

EXPERIENCE : ? Experience working and knowledge of a variety of healthcare data sources including claims data, payor revenue / premium data, payor supplemental data, clinical data including clinical quality metrics (HEDIS) and risk adjustment (HCCs), social determinants of health (SDOH), and operational data and KPIs.

Preferred Experience

LICENSURE / CERTIFICATION / REGISTRY / LISTING :

Equal Opportunity Employer At Cone Health, we strive to create a welcoming atmosphere that celebrates a diverse and unique workforce. We believe in offering equal opportunities for employment to all applicants and employees, regardless of their race, religion, age, sex, sexual orientation, gender identity, veteran's status, ethnicity, national origin, disability, color, or any other characteristic protected by law. Our hiring and employment choices are based on each individual's qualifications, skills and performance. We believe that by embracing the diversity of our team, we can better serve our patients, communities and each other.