VP-Analytics-Health Plan

Summary

Location Address:
Remote Office St Paul, MN 55155. The Vice President, Health Plan Analytics is the senior leader accountable for advancing analytics and insights across Presbyterian Health Plan. Reporting to the Chief Analytics & Data Officer, this role ensures Health Plan strategy and operations are supported by accurate, timely, and decision‑ready analytics that improve affordability, quality, growth, and member experience. This leader is responsible for regulatory reporting, quality performance analytics, medical cost management, revenue optimization, provider network analytics, and member operations reporting.

The VP will modernize and integrate fragmented data environments into a connected and governed platform that supports measurable business value, operational reliability, and value‑based care performance. The ideal candidate brings deep payer experience, has led Health Plan analytics at scale, and understands how to translate complex data into actionable insights that improve financial and operational outcomes. This role also carries significant responsibility for developing talent and building a strong leadership bench within the analytics function.

This position reflects Presbyterian’s values of excellence, stewardship, integrity, and compassion and aligns with our analytics commitment to serve with purpose, grow experts, and build what is next.

• Remote:
  Open to applicants in the United States, excluding CA, IL, ND, NY, OH, WA, and WY.
• Hybrid:
  For individuals within 60 miles of Albuquerque, in‑office presence is required Tuesday through Thursday.

• 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,…