VNS Health
Overview
We are seeking a strategic professional to serve as the Manager of Clinical Performance and Cost Optimization. This role is responsible for overseeing and advancing Managed Care Initiatives (MCI) and Medical Expense (MedEx) optimization efforts across our health plans.
The successful candidate will be skilled at interpreting dashboards and clinical data insights to identify cost optimization opportunities, support clinical performance enhancement projects, and inform business units on areas for improvement-all while ensuring alignment with financial and quality objectives.
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.
Qualifications 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
Pay Range USD $98,200.00 - USD $130,800.00 /Yr.
About Us VNS Health is one of the nation's largest nonprofit home and community-based health care organizations. Innovating in health care for more than 130 years, our commitment to health and well-being is what drives us - we help people live, age and heal where they feel most comfortable, in their own homes, connected to their family and community. On any given day, more than 10,000 VNS Health team members deliver compassionate care, unparalleled expertise and 24/7 solutions and resources to the more than 43,000 "neighbors" who look to us for care. Powered and informed by data analytics that are unmatched in the home and community-health industry, VNS Health offers a full range of health care services, solutions and health plans designed to simplify the health care experience and meet the diverse and complex needs of the communities and people we serve in New York and beyond.
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The successful candidate will be skilled at interpreting dashboards and clinical data insights to identify cost optimization opportunities, support clinical performance enhancement projects, and inform business units on areas for improvement-all while ensuring alignment with financial and quality objectives.
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.
Qualifications 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
Pay Range USD $98,200.00 - USD $130,800.00 /Yr.
About Us VNS Health is one of the nation's largest nonprofit home and community-based health care organizations. Innovating in health care for more than 130 years, our commitment to health and well-being is what drives us - we help people live, age and heal where they feel most comfortable, in their own homes, connected to their family and community. On any given day, more than 10,000 VNS Health team members deliver compassionate care, unparalleled expertise and 24/7 solutions and resources to the more than 43,000 "neighbors" who look to us for care. Powered and informed by data analytics that are unmatched in the home and community-health industry, VNS Health offers a full range of health care services, solutions and health plans designed to simplify the health care experience and meet the diverse and complex needs of the communities and people we serve in New York and beyond.
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