Manager, Healthcare Economics

Overview

Advanced Care Innovations is a provider-led, community-focused healthcare organization dedicated to improving the health and well-being of populations with complex medical and social needs. We partner with medical groups focused on delivering care to patients during the neediest period of their lifetime. ACI delivers solutions to our network of practice partners focused on delivering personalized care as close to home as possible and partner with providers to enable better outcomes through data-driven insights and innovative value-based solutions.

Education

• Bachelor’s degree in economics, statistics, mathematics, actuarial science, or related field, OR 3+ years of equivalent experience in healthcare economics.
• Master’s degree in a related field preferred.

Experience

• 3+ years of data & analytics, and healthcare experience within a payer, provider, MSO, or managed care organization.
• ACO experience strongly preferred.
• Strong proficiency in Excel; working knowledge of SQL, SAS, Python, or R.
• Experience with enterprise data warehouses and claims data is preferred.
• Strong communication, problem‑solving skills, and attention to detail.

Knowledge, Skills & Attributes

• Expertise in claims analytics, utilization modeling, and healthcare financial forecasting.
• Ability to build and maintain effective provider and internal team relationships.
• Strong data visualization and presentation skills.
• High integrity, sound judgment, and a collaborative mindset.

About the Job

The Manager of ACO healthcare economics supports financial, analytical, and operational functions related to Advanced Care Innovations’ ACO and value-based care programs. They support the head of healthcare economics on program finance, medical economics, risk adjustment, and ACO REACH financial methodologies.

Primary Responsibilities

• Support analytics and reporting needs related to medical trends, utilization, cost, and financial performance across value-based arrangements
• Prepare reports, dashboards, and presentations highlighting key contractual performance metrics
• Conduct ad hoc analyses upon request merging and validating large claims datasets
• Manage CMS data submissions and interactions through systems such as 4i.
• Support interpretation and communication of value‑based care arrangements
• Support design and evaluation of targeted clinical or operational interventions
• Develop standard processes, tools, and documentation for analytics workflows
• Serve as a subject matter expert on ACO financial methodologies
• Maintain strong relationships with provider partners and serve as primary liaison on program performance and financial reconciliation
• Partner with IT to oversee claims data QA processes, including completeness checks and validation of key metrics
• Partner with Medical Directors, Finance, and Operations to design and track performance improvement initiatives
• Forecast end‑of‑year performance, support budget development, and model CMS rule changes
• Monitor initiative effectiveness and recommend refinements
• Prepare and present P&L reports to partner leadership
• Estimate partner payments and oversee monthly disbursements and settlement processes
• Stay current on ACO REACH (LEAD) program updates and integrate insights into program planning

Advanced Care Innovations offers healthcare benefits for employees working an average of 30+ hours per week. The cost of healthcare is shared between the company and the employee

Working Environment & Physical Requirements

Work is performed indoors in a professional environment. Travel to partner offices may be required. Ability to communicate effectively via phone and email is essential. Extended periods of sitting and computer use are common. Must be able to lift up to 10 lbs occasionally and review detailed documents and reports