Strategic Analytics Manager, Quality Reimbursement & Value-Based Care

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Adventist HealthCare seeks to hire an experienced Strategic Analytics Manager for our Quality Reimbursement & Value-Based Care team who will embrace our mission to extend God’s care through the ministry of physical, mental, and spiritual healing.

The Strategic Analytics Manager will serve as a subject-matter expert in Maryland hospital quality reimbursement, value-based payment, and strategic healthcare analytics.

• This role will lead the replication, validation, interpretation, forecasting, and performance monitoring of HSCRC and CMS financial and quality payment models, using claims, financial, quality, utilization, and total-cost-of-care data. The Manager will apply expertise in risk adjustment methodologies, grouping methods, statistical approaches, benchmarking, and payment policy to assess organizational performance and translate complex regulatory and reimbursement requirements into actionable financial, clinical, and operational insights.
• The role will have particular responsibility for Maryland Health Services Cost Review Commission (HSCRC) quality methodologies while supporting the organization's evolving analytics needs under CMS quality programs and the AHEAD Model. The Manager will partner closely with Quality, Population Health, Care Management, Finance, Clinical Operations, and other stakeholders to connect quality performance, utilization, reimbursement, and organizational strategy.
• Adventist HealthCare's Strategic Analytics team operates through a portfolio model. While this position's primary subject-matter focus is quality, population health, and value-based care, the Manager may also lead or contribute to cross-functional analytics initiatives outside the core portfolio to support enterprise priorities, collaboration, and professional development.

As a Strategic Analytics Manager you will: Reimbursement, Payment Policy & Methodology Analytics

• Serve as a subject-matter expert on HSCRC quality reimbursement methodologies, Maryland's hospital global budget environment, CMS quality programs, and the interaction of Maryland and federal payment models.
• Replicate, validate, maintain, and forecast HSCRC and CMS financial and quality policy models, ensuring analytical results appropriately reflect published methodologies, technical specifications, and regulatory guidance.
• Interpret and operationalize HSCRC, CMS/CMMI, CRISP, and other relevant regulatory guidance, technical specifications, payment methodologies, and reporting requirements.
• Apply risk adjustment methodologies, grouping and attribution methods, statistical techniques, benchmarking approaches, measure specifications, scoring methodologies, and performance thresholds to evaluate organizational performance and reimbursement exposure.
• Analyze claims, financial, quality, utilization, clinical, and total-cost-of-care data to identify performance drivers, risks, and improvement opportunities.
• Translate complex payment policy, regulatory guidance, and analytical findings into actionable financial, clinical, and operational insights for executive and operational leaders.
• Develop and maintain analytical methodologies for current and emerging quality and value-based payment programs, including:
• HSCRC Quality-Based Reimbursement (QBR)
• Readmissions Reduction Incentive Program (RRIP)
• Maryland Hospital Acquired Conditions (MHAC)
• Potentially Avoidable Utilization (PAU) and successor methodologies
• CMS Hospital Value-Based Purchasing (HVBP)
• Hospital Readmissions Reduction Program (HRRP)
• Hospital-Acquired Condition Reduction Program (HACRP)
• AHEAD-related hospital quality, population health, and payment adjustments
• Other state and federal value-based payment programs, as applicable
• Monitor emerging state and federal reimbursement policies and assess potential organizational financial and operational impacts.
• Maintain comprehensive documentation of methodologies, assumptions, data sources, calculation logic, validation processes, and analytical controls.

Financial Modeling, Forecasting & Strategic Decision Support

• Develop financial models to estimate the impact of quality performance, reimbursement policy changes, utilization trends, population health outcomes, and operational initiatives.
• Perform scenario analysis, sensitivity modeling, forecasting, and performance-driver analysis for HSCRC, CMS, AHEAD, and other value-based payment programs.
• Reconcile internal model results against regulatory, payer, or external benchmarks and investigate material variances.
• Identify the clinical, operational, utilization, population, and financial factors driving performance and reimbursement outcomes.
• Develop short- and long-term projections to support strategic planning, performance management, and resource prioritization.
• Apply appropriate economic, statistical, benchmarking, and healthcare measurement methodologies to evaluate organizational performance.
• Present reimbursement analyses, policy implications, risks, opportunities, and strategic recommendations to executive and operational leadership.

Performance Reporting, Data & Analytics

• Design and maintain enterprise analytics, dashboards, scorecards, and performance management tools related to quality reimbursement, population health, total cost of care, and value-based care.
• Monitor HSCRC and CMS quality payment performance, AHEAD-related measures and adjustments, population health and disparities measures, and other strategic quality KPIs.
• Analyze large and complex healthcare datasets, including:
• HSCRC case-mix data
• CRISP data
• Medicare claims and beneficiary-level data
• Financial and reimbursement data
• Quality and clinical data
• Utilization and population health data
• Total-cost-of-care data
• Integrate multiple data sources to evaluate relationships among quality, utilization, financial performance, reimbursement, and patient outcomes.
• Establish robust data validation, reconciliation, and quality-control processes to ensure reliable and reproducible analytics.
• Develop scalable analytical solutions using SQL, Power BI, Excel, Tableau, and other enterprise analytics platforms.

Leadership, Collaboration & Stakeholder Engagement

• Lead complex enterprise analytics projects from problem definition and methodology development through implementation, communication, and performance monitoring.
• Partner with Quality, Population Health, Care Management, Finance, Clinical Operations, and other leaders to identify opportunities and develop evidence-based performance strategies.
• Translate complex reimbursement methodologies, statistical analyses, regulatory requirements, and policy changes into clear and actionable insights for executive, clinical, financial, and operational audiences.
• Lead and mentor analysts and other team members, establishing standards for analytical quality, methodology replication, documentation, project management, and timely delivery.
• Support the development of standardized analytical processes, databases, reporting tools, and methodologies across the organization.
• Represent Adventist HealthCare, as appropriate, in external regulatory, policy, and industry forums and workgroups, including those involving HSCRC, the Maryland Hospital Association, CMS/CMMI, CRISP, and other stakeholders.
• Provide education and training to internal stakeholders on quality payment methodologies, regulatory changes, analytical interpretation, and performance implications.

Strategic Analytics Portfolio

• Contribute to analytics initiatives outside the primary quality reimbursement portfolio based on organizational priorities and team needs.
• Apply strategic, financial, operational, statistical, and data analytics capabilities to emerging enterprise questions and cross-functional initiatives.
• Promote analytical consistency, knowledge sharing, and collaboration across subject-matter areas.

Qualifications include

Required

• Bachelor's degree in finance, economics, healthcare administration, public health, data analytics, statistics, business administration, or a related quantitative or healthcare field.
• Seven or more years of progressive experience in healthcare analytics, reimbursement, payment policy, decision support, medical economics, or a related field.
• Demonstrated expertise in Maryland's HSCRC environment, including hands-on experience replicating, validating, interpreting, or forecasting HSCRC financial and/or quality payment methodologies, with particular depth in quality reimbursement.
• Demonstrated experience developing or replicating complex healthcare reimbursement, quality, or value-based payment models.
• Strong understanding of Maryland's hospital global budget framework, Total Cost of Care principles, and quality/value-based payment programs.
• Experience analyzing HSCRC case-mix data and other large healthcare claims, financial, quality, utilization, or operational datasets.
• Demonstrated knowledge and application of risk adjustment methodologies, grouping or attribution methods, statistical approaches, benchmarking techniques, measure specifications, scoring methodologies, and performance target setting.
• Ability to integrate and analyze claims, financial, quality, utilization, and total-cost-of-care data to evaluate organizational performance and identify actionable opportunities.
• Demonstrated ability to translate complex payment policy and analytical findings into clear, actionable recommendations for executive, clinical, financial, and operational audiences.
• Advanced proficiency with SQL, Excel, and data visualization/business intelligence tools such as Power BI or Tableau.
• Strong critical thinking, quantitative analysis, problem-solving, project management, and written and verbal communication skills.
• Demonstrated leadership of complex analytics projects and teams, including experience coaching or developing analysts and managing multiple priorities and deliverables.
• Demonstrated ability to rapidly learn, interpret, replicate, and operationalize new reimbursement and quality methodologies as state and federal payment models evolve.

Preferred

• Master's degree in healthcare administration, public health, business administration, finance, economics, data science, statistics, or a related field.
• Three or more years of direct people-management experience or comparable leadership of complex analytical teams and portfolios.
• Experience replicating or analyzing CMS hospital financial or quality payment methodologies, including HVBP, HRRP, HACRP, or related national value-based payment programs.
• Knowledge of the CMS/CMMI AHEAD Model and its implications for Maryland hospital global budgets, quality performance, total cost of care, and value-based care.
• Experience with Medicare claims or beneficiary-level data, including CCLF and/or CCW data.
• Experience working with CRISP data and reporting services.
• Experience in population health, medical economics, actuarial informatics, predictive analytics, or value-based care analytics.
• Experience with advanced statistical analysis and tools such as Python, R, SAS, or comparable platforms is a plus.

Work Schedule: Full-time, hybrid position

Pay Range

$116,227.90 - $177,756.80

If the salary range is listed as $0 or if the position is Per Diem (with a fixed rate), salary discussions will take place during the screening process.

Under the Fair Labor Standards Act (FLSA), this position is classified as:

United States of America (Exempt)

At Adventist HealthCare our job is to care for you.

We do this by offering

• Work life balance through nonrotating shifts
• Recognition and rewards for professional expertise
• Free Employee parking
• Medical, Prescription, Dental, and Vision coverage for employees and their eligible dependents effective on your date of hire
• Employer-paid Short & Long-Term Disability, Basic Life Insurance and AD&D, (short-term disability buy-up available)
• Paid Time Off
• Employer retirement contribution and match after 1-year of eligible employment with a 3-year vesting period
• Voluntary benefits include flexible spending accounts, legal plans, and life, pet, auto, home, long term care, and critical illness & accident insurance
• Subsidized childcare at participating childcare centers
• Tuition Reimbursement
• Employee Assistance Program (EAP) support

As a faith-based organization, with over a century of caring for the communities in the Maryland area, Adventist HealthCare has earned a reputation for high-quality, compassionate care. Adventist HealthCare was the first and is the largest healthcare provider in Montgomery County.

If you want to make a difference in someone’s life every day, consider a position with a team of professionals who are doing just that, making a difference.

Join the Adventist HealthCare team today, apply now to be considered!

COVID-19 Vaccination

Adventist HealthCare strongly recommends all applicants to be fully vaccinated for COVID-19 before commencing employment. Applicants may be required to furnish proof of vaccination.

Tobacco and Drug Statement

Tobacco use is a well-recognized preventable cause of death in the United States and an important public health issue. In order to promote and maintain a healthy work environment, Adventist HealthCare will not hire applicants for employment who either state that they are nicotine users or who test positive for nicotine and drug use.

While some jurisdictions, including Maryland, permit the use of marijuana for medical purposes, marijuana continues to be classified as an illegal drug under the federal Controlled Substances Act. As a result, medical marijuana use will not be accepted as a valid explanation for a positive drug test result.

Adventist HealthCare will withdraw offers of employment to applicants who test positive for Cotinine (nicotine) and marijuana. Those testing positive are given the opportunity to re-apply in 90 days, if they can truthfully attest that they have not used any nicotine products in the past ninety (90) days and successfully pass follow-up testing. ("Nicotine products" include, but are not limited to: cigarettes, cigars, pipes, chewing tobacco, e-cigarettes, vaping products, hookah, and nicotine replacement products (e.g., nicotine gum, nicotine patches, nicotine lozenges, etc.).