Note: The job is a remote job and is open to candidates in USA. Presbyterian Healthcare Services is a not-for-profit healthcare 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 insight generation.
Responsibilities
- Set and execute the strategic direction for Health Plan analytics in alignment with enterprise priorities for affordability, quality, growth, and member experience
- Define clear value realization targets for analytics initiatives, linking analytic outputs to measurable financial, regulatory, and operational impact
- Establish a structured operating model including KPI governance, metric ownership, intake prioritization, and disciplined executive reporting cadences
- Drive insight generation that informs strategic decisions, performance improvement initiatives, and investment priorities
- Partner closely with Health Plan executive leadership to ensure analytics are embedded in business planning and operational reviews
- Lead all regulatory and compliance analytics including HCA and non-HCA reporting, state and federal submissions, encounter data oversight, and audit readiness
- Oversee performance analytics for HEDIS, Medicare Stars, CAHPS, HOS, QRS, and accreditation requirements such as NCQA
- Maintain accurate, timely, and defensible reporting processes supported by strong documentation and internal controls
- Provide executive oversight for analytics supporting claims, appeals and grievances, call center operations, and member service performance
- Strengthen governance and quality assurance processes to ensure regulatory compliance and high confidence in reported results
- Oversee claims analytics, total cost of care reporting, revenue management support, and collaboration on risk adjustment performance
- Lead unit cost analysis, medical trend monitoring, PCP attribution redesign, and provider directory data integrity
- Support encounter submission accuracy, payment integrity programs, and financial forecasting
- Provide actionable insights to optimize performance across utilization management, pharmacy management, and network economics
- Partner with Sales and Marketing to support product performance analytics, enrollment, retention, and billing accuracy
- Support provider network strategy and contracting through transparent and actionable cost and quality reporting
- Enable 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
- Integrate claims, clinical, pharmacy, and social determinants data to support performance improvement and care management initiatives
- Lead and integrate population health analytics as a core capability within Health Plan performance, advancing risk stratification, segmentation, care gap identification, and equity insights to improve quality, cost, and outcomes across member populations
- Drive alignment between payer and provider perspectives by connecting claims, clinical, pharmacy, and social determinants data to enable value-based care, care management effectiveness, and proactive intervention strategies
- Ensure population health insights are embedded into operational workflows, program design, and performance management, with clear linkage to total cost of care, quality improvement, and health equity outcomes
- Partner closely with Information Technology leadership to align analytic strategy with enterprise data architecture and platform modernization efforts
- Lead the integration of Health Plan data assets into a scalable, 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 integrity
- Define and enforce data quality standards, validation processes, and metric governance to ensure high-quality analytics
- Develop 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 insight generation
- Build and lead a high-performing Health Plan analytics organization with clear accountability and performance expectations
- Develop Directors and senior managers through active coaching, structured development plans, and succession planning
- Establish competency models and career pathways that strengthen analytic, technical, and business capabilities
- Cultivate future enterprise analytics leaders and expand analytic literacy across Health Plan leadership
- Foster a culture of ownership, collaboration, continuous 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 related field
- 15 or more years of progressive leadership experience in Health Plan analytics within 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-aligned performance programs
- Proven oversight of claims analytics, total cost of care reporting, revenue performance, and provider analytics
- Experience supporting provider network strategy, 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 modernize analytic platforms and strengthen data governance
- Track record of building and developing high-performing analytics teams
- Deep knowledge of payer regulatory frameworks, compliance analytics, and quality measurement
- Strong understanding of claims data, risk adjustment methodologies, and Health Plan financial drivers
- Ability to connect analytics to measurable business outcomes
- Strong partnership orientation with IT, Finance, Operations, and Clinical leadership
- Expertise in data governance, master data management, and data quality assurance
- Ability to translate complex data into clear, actionable insights for executive and operational leaders
- Commitment to integrity, stewardship, and continuous improvement
- Demonstrated success developing talent and strengthening organizational capability
- Advanced degree or relevant actuarial, clinical, or quality credential preferred
Benefits
- Benefits are effective day-one (for .45 FTE and above) and include:
- Full medical, dental and vision insurance
- Flexible spending accounts (FSAs)
- Free wellness programs
- Paid time off (PTO)
- Retirement plans, including matching employer contributions
- Continuing education and career development opportunities
- Life insurance and short/long term disability programs
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