Manager, Clinical Performance & Cost Optimization

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
• Employer-matched retirement saving funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

What You Will Do

• Monitors cost and utilization trends daily, identifying opportunities for clinical program enhancement and cost containment.
• Works cross-functionally with internal and external partners (e.g., Utilization Management, Care Management, Actuarial, Health Economics, IT, Claims, Risk Adjustment, and Provider Network) to ensure initiatives drive measurable financial and clinical improvements.
• Serves as key contact for MCI/MedEx initiatives, ensuring effective execution, coordination, and visibility across teams.
• Analyzes and sizes clinical cost optimization opportunities at least annually, ensuring financial feasibility and alignment with clinical objectives.
• Supports the adoption of evidence-based clinical interventions to improve quality while optimizing costs.
• Partners closely with analytics and finance teams (Actuarial, Health Economics, Business Intelligence & Analytics) to develop and refine cost-management metrics and assess initiative impact.
• Interprets and acts on cost trend reports, proactively identifying outliers, flagging high-risk members, and working with clinical teams to optimize interventions.
• Supports and drives initiatives that enhance efficiency, reduce medical costs, and improve care coordination.
• Prepares executive-level reports and presentations, translating complex cost trends into actionable insights for leadership.
• Monitors provider cost and quality performance, ensuring contract alignment and performance accountability.
• Defines, tracks, and refines OKRs for MedEx and MCI initiatives, ensuring measurable impact.
• Partners with clinical teams to design and evaluate programs aimed at reducing avoidable admissions, readmissions, and unnecessary utilization.
• Performs all duties inherent in a managerial role, including hiring, training, developing, recommending salary actions and when necessary, terminating staff.
• Participates in special projects and performs other duties as assigned.

Education:

• Bachelor's Degree in healthcare administration, business, finance, public health, or a related field required
• Master's Degree in healthcare administration, business, finance, public health, or a related field preferred

Work Experience:

• Minimum of five years of experience in healthcare operations required
• Data-driven mindset with strong analytical skills, experience in cost analysis, and a passion for making data-informed decisions required
• Excellent stakeholder management and ability to communicate complex data insights to diverse audiences required
• Ability to work across clinical, financial, and operational teams to execute and measure cost-containment strategies required
• Experience with Medicare and Medicaid operations, risk adjustment, claims, and value-based care models preferred
• Data-driven mindset to continuously monitor cost trends, analyze financial and utilization patterns, develop insights, and support decision-making to ensure initiatives are impactful and aligned with organizational goals required
• Highly analytical, comfortable working with data, and experienced in collaborating with clinical, financial, and operational teams required