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 shari