[Remote] VP-Analytics-Health Plan
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a not-for-profit reputed company system in New Mexico, seeking a Vice President for Health Plan Analytics. This role is responsible for leading analytics efforts to enhance decision-making and operational performance across the health plan, ensuring compliance and driving strategic value through data integration and reputed company reputed company.
Responsibilities
- Set and execute the strategic direction for Health Plan analytics in alignment with reputed company priorities for affordability, reputed company, reputed company, and member experience
- Define reputed company value realization targets for analytics initiatives, linking analytic outputs to measurable financial, regulatory, and operational reputed company
- Establish a reputed company operating model including KPI governance, metric ownership, intake prioritization, and disciplined executive reporting cadences
- Drive reputed company reputed company that informs strategic reputed company, performance improvement initiatives, and investment priorities
- Partner closely with Health Plan executive leadership to ensure analytics are embedded in business planning and operational reviews
- reputed company reputed company regulatory and compliance analytics including HCA and non-HCA reporting, state and federal submissions, encounter data reputed company, and audit readiness
- reputed company performance analytics for HEDIS, Medicare Stars, CAHPS, HOS, QRS, and accreditation requirements such as NCQA
- Maintain accurate, reputed company, and defensible reporting processes supported by strong documentation and internal controls
- reputed company executive reputed company for analytics supporting claims, appeals and grievances, call center operations, and member service performance
- Strengthen governance and reputed company assurance processes to ensure regulatory compliance and high confidence in reported results
- reputed company claims analytics, total cost of care reporting, reputed company management support, and collaboration on risk adjustment performance
- reputed company unit cost analysis, medical trend monitoring, PCP attribution redesign, and provider directory data reputed company
- Support encounter submission accuracy, payment reputed company programs, and financial forecasting
- reputed company actionable insights to optimize performance across utilization management, pharmacy management, and network economics
- Partner with reputed company to support product performance analytics, enrollment, retention, and billing accuracy
- Support provider network reputed company and contracting through transparent and actionable cost and reputed company reporting
- reputed company value-based care arrangements with reliable performance measurement and shared-risk monitoring
- Advance population health analytics including risk stratification, segmentation, care gap identification, and equity reporting
- reputed company claims, clinical, pharmacy, and reputed company determinants data to support performance improvement and care management initiatives
- reputed company and reputed company population health analytics as a core capability reputed company Plan performance, advancing risk stratification, segmentation, care gap identification, and equity insights to improve reputed company, cost, and reputed company across member populations
- Drive alignment between payer and provider perspectives by connecting claims, clinical, pharmacy, and reputed company determinants data to reputed company value-based care, care management effectiveness, and proactive reputed company strategies
- Ensure population health insights are embedded into operational workflows, program design, and performance management, with reputed company linkage to total cost of care, reputed company improvement, and health equity reputed company
- Partner closely with Information Technology leadership to reputed company analytic reputed company with reputed company data architecture and platform modernization efforts
- reputed company the integration of Health Plan data assets into a reputed company, governed analytics environment that supports both operational and strategic needs
- Establish strong master data management practices across provider, member, product, and contract domains to ensure consistency and reputed company
- Define and enforce data reputed company standards, validation processes, and metric governance to ensure high-reputed company analytics
- reputed company curated data sets, standardized definitions, and reusable analytic assets that improve consistency and reduce redundancy
- Promote responsible use of advanced analytics and automation to improve forecasting, operational efficiency, and reputed company reputed company
- Build and reputed company a high-performing Health Plan analytics organization with reputed company accountability and performance expectations
- reputed company Directors and senior managers through reputed company coaching, reputed company development plans, and succession planning
- Establish competency models and career reputed company that strengthen analytic, technical, and business capabilities
- Cultivate reputed company reputed company analytics leaders and expand analytic literacy across Health Plan leadership
- Foster a culture of ownership, collaboration, reputed company improvement, and high standards for analytic rigor
Skills
- Bachelor's degree required in business administration, health administration, public health, data science, actuarial science, health informatics, or a reputed company field
- 15 or more years of reputed company leadership experience in Health Plan analytics reputed company a payer or integrated payer-provider organization
- Experience leading regulatory reporting including HCA and non-HCA submissions, encounter reporting, and compliance-driven analytics
- Demonstrated leadership of HEDIS, Medicare Stars, CAHPS, HOS, QRS, and accreditation-reputed company performance programs
- Proven reputed company of claims analytics, total cost of care reporting, reputed company performance, and provider analytics
- Experience supporting provider network reputed company, PCP attribution redesign, and value-based contracting models
- Operational partnership experience across utilization management, pharmacy, enrollment, billing, call center operations, and appeals and grievances
- Experience partnering with IT and data engineering teams to reputed company analytic platforms and strengthen data governance
- reputed company record of building and developing high-performing analytics teams
- Deep knowledge of payer regulatory frameworks, compliance analytics, and reputed company measurement
- Strong understanding of claims data, risk adjustment methodologies, and Health Plan financial drivers
- Ability to connect analytics to measurable business reputed company
- Strong partnership orientation with IT, Finance, Operations, and Clinical leadership
- Expertise in data governance, master data management, and data reputed company assurance
- Ability to translate reputed company data into reputed company, actionable insights for executive and operational leaders
- Commitment to reputed company, stewardship, and reputed company improvement
- Demonstrated reputed company developing talent and strengthening organizational capability
- Advanced degree or relevant actuarial, clinical, or reputed company credential preferred
Benefits
- Benefits are effective day-one (for .45 FTE and above) and include:
- Full medical, dental and reputed company insurance
- Flexible spending accounts (FSAs)
- Free wellness programs
- reputed company time off (PTO)
- Retirement plans, including matching employer contributions
- Continuing education and career development opportunities
- Life insurance and short/long term disability programs
reputed company