Director, Network Strategy & Analytics (Medicare Advantage / Value-Based Care) - Kelsey - Seybold Clinics, Pearland TX.

Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together.

The Payor Contracting Analytics Director serves as an analytical leader responsible for driving the financial, analytical, and operational components of Kelsey Seybold's payer contracting strategy. This role oversees complex reimbursement modeling and partners cross functionally to ensure successful contract negotiations and implementation of new agreements. The Payor Contracting Analytics, Director plays a critical role in shaping the organization's capitation and value-based care portfolio, identifying opportunities for growth, and ensuring financial sustainability across all contract types.

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications

• 10+ years of Health Care or Health Plan analytical experience
• Extensive experience with SQL servers, SAP, data management systems, including but not limited to Excel, Access, and Microsoft Data Services. Knowledge of CMS rules and regulations, Managed Care payment methodologies, and proficient in MS office products, and Power BI
• Experience working with claims and large healthcare datasets and solid understanding of payer financial models and cost structures
• Experience applying AI enabled analytics tools (e.g., automated insights, predictive modeling, and intelligent reporting features within platforms such as Power BI or SQL based environments) to support healthcare financial analysis and decision making
• Healthcare & Texas Market knowledge with a solid understanding of Medicare Advantage Reimbursement and risk adjustment, ACA Marketplace dynamics, capitation and value-based models. Understanding of: Provider reimbursement methodologies (e.g., % of Medicare, DRG, case rates)
• Proven excellent written and verbal communication skills, solid analytical and problem-solving abilities and high attention to detail

Preferred Qualifications

• EPIC
• Experience with Power BI or equivalent business intelligence / dashboarding tools to support reporting and visualization needs
• Experience supporting or analyzing value-based care arrangements, including shared savings and shared risk models
• Experience analyzing reimbursement as a percentage of CMS/Medicare rates
• Experience within healthcare payer/provider contracting (medical groups, health plans, ASC, or similar)
• Experience evaluating high-cost drugs or capitation carve-out decisions
• Direct experience leading financial modeling for capitation (professional, global, or POP-based contracts)
• Solid understanding of Medicare Advantage payment structures and reimbursement methodologies, including revenue drivers tied to MA plans
• Demonstrated ability to apply data analytics within payer contracting environments, including working with large datasets and translating insights into financial or strategic recommendations
• Have supported or led modeling/negotiations for value-based care contracts (shared savings, shared risk)
• Have led projects or teams responsible for contract strategy, financial analysis, or payer negotiations (manager-level or higher)
• Have led or owned implementation of payer/provider contracts across cross-functional teams (Finance, IT, Claims, Ops)
• Have used transparency/vendor rate data for negotiation strategy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $112,700 to $193,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.