Director, Managed Care Analytics

The Director, Managed Care Analytics serves as an enterprise leader within a health care system for payer analytics, contract modeling, and contract performance optimization. This role is responsible for developing advanced financial, statistical, and predictive models to support managed care contracting strategy, value-based care performance, and revenue optimization.

The Director transforms traditional analytics into a modern, AI-enabled decision support function by leveraging automation, machine learning, and advanced data platforms to deliver predictive, prescriptive, and real-time insights across the payer lifecycle.

This position partners closely with Patient Business Services, Revenue Integrity, Patient Access, Finance, Clinical Operations, and Information Technology to ensure data integrity, actionable insights, and alignment with organizational priorities. The Director serves as a strategic advisor to executive leadership on payer strategy, contract performance, reimbursement optimization, and value-based care initiatives.

Additionally, the Director helps guide AI governance and the responsible use of data and analytics across the health care system, ensuring transparency, regulatory compliance, ethical use of artificial intelligence, and appropriate human oversight in decision-support processes.

What Success Looks Like:

Within the first 12 to 24 months, the Director will:

Establish a scalable, enterprise-wide payer analytics framework that integrates claims, clinical, and contract data into a unified decision-support capability.

Deliver measurably enhanced visibility into payer performance across all major lines of business, enabling proactive contract management and revenue optimization.

Deploy initial AI-enabled workflows supporting contract performance monitoring, underpayment detection, and denial prevention.

Strengthen strategic alignment between payer relations, revenue cycle operations, and clinical leadership through shared data and analytics infrastructure.

Elevate analytics as a recognized strategic driver of payer performance, financial outcomes, and organizational growth.

Education/Experience:

Education
Required: Bachelor’s Degree in Finance, Healthcare Administration, Data Analytics, Statistics, or a related field.
Preferred: Master’s degree (MBA, MHA, Health Informatics, Data Science, or equivalent). Graduate-level preparation is strongly preferred for this enterprise analytics leadership role.

Experience
8 or more years of progressive experience in healthcare analytics, decision support, or revenue cycle analytics.
3 to 5 or more years in a leadership or management role.
Demonstrated experience leading payer contract modeling and supporting negotiation strategy.
Experience with value-based care and alternative payment models.
Experience building or modernizing analytics capabilities preferred.

Technical and Functional Expertise
Advanced proficiency in Excel and data modeling.
Advanced proficiency in BI tools such as Tableau.
Experience with healthcare data including claims, clinical records, and EHR data.
Experience with contract modeling tools and systems.
Working knowledge of AI applications in healthcare analytics.
Working knowledge of predictive modeling.

Domain Knowledge
Strong working knowledge of Medicare Advantage, Medicaid (including Texas programs), and commercial exchange products.

Strong knowledge of reimbursement methodologies and contract structures.
Familiarity with data integration challenges in healthcare.

LICENSURE
HFMA certification preferred.
Epic Resolute expected reimbursement certification required.