Program Manager Healthcare Financial Analytics- Health Plan

Are you looking for a career that offers both purpose and the opportunity for growth? Parkland Community Health Plan (PCHP) is a proud member of the Parkland Health family.  PCHP is a Medicaid Managed Care Organization servicing Texas Medicaid and CHIP in the Dallas Service Area.  PCHP works to fulfill of our mission by empowering members to live healthier lives.  By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job—it’s a passion to serve and improve lives every day.

Primary Purpose

The Program Manager, Healthcare Financial Analytics is responsible for leading the development, maintenance, and enhancement of cost and utilization reporting for Parkland Community Health Plan (PCHP). This role provides actionable insights to support financial planning, actuarial forecasting, and executive decision-making. The position also serves as a key backup for Financial Statistical Report (FSR) preparation and supports compliance with state reporting requirements. The ideal candidate will have a strong understanding of Medicaid and ACA risk adjustment methodologies and their financial implications.

Minimum Specifications

Education

• Bachelor’s degree in Finance, Actuarial Science, Economics, Public Health, or a related field.
• Master’s degree or professional certification (e.g., ASA, CPA, MHA) preferred.

Experience

• Minimum five (5) years of experience in healthcare analytics, actuarial analysis, or financial planning within a managed care or health plan environment.
• Experience with cost and utilization reporting, claims data analysis, and risk adjustment methodologies required.
• Familiarity with Medicaid and ACA programs and regulatory reporting (e.g., FSR) strongly preferred.

Skills or Special Abilities

• Strong analytical and quantitative skills with the ability to interpret complex healthcare data.
• Proficiency in SQL, Excel, and data visualization tools (e.g., Power BI, Tableau).
• Working knowledge of risk adjustment models (e.g., CDPS, HHS-HCC) and their financial impact.
• Ability to communicate technical findings to non-technical stakeholders.
• Detail-oriented with strong organizational and project management skills.
• Ability to work independently and collaboratively across departments.

Responsibilities

Financial Analytics

• Develop and maintain recurring cost and utilization reports to support finance and executive leadership.
• Analyze medical and pharmacy claims data to identify trends, cost drivers, and opportunities for cost containment.
• Collaborate with actuarial and FP&A teams to support forecasting, budgeting, and premium deficiency reserve analysis.
• Serve as a backup for FSR preparation, including data validation, encounter reconciliation, and compliance with HHSC requirements.
• Support the development of risk adjustment analytics for Medicaid lines of business.
• Assist in the development of dashboards and tools to monitor performance against financial and operational benchmarks.
• Participate in cost-of-care initiatives and support ad hoc analyses related to provider reimbursement, utilization patterns, and program evaluation.

Quality

• Integrate health literacy principles into all communication including Members and Providers.
• Support strategies that meet clinical, quality and network improvement goals.
• Promote the use of Health Information Technology to support and monitor the effectiveness of health and social interventions and make data-driven recommendations as needed.
• For staff in clinical roles, foster collaborative relationships with members and/or providers to promote and support evidence-based practices and care coordination.

Regulatory

• Ensure work is carried out in compliance with regulatory and/or accreditation standards as well as contractual requirements.
• Ensure data integrity and alignment between internal systems, data warehouse, and regulatory submissions.
• Stay current on regulatory changes, risk adjustment methodologies, and industry best practices.

Professional Accountability

• Promotes and supports a culturally welcoming and inclusive work environment.
• Acts with the highest integrity and ethical standards while adhering to Parkland's Mission, Vision, and Values.
• Adheres to organizational policies, procedures, and guidelines.
• Completes assigned training, self-appraisal, and annual health requirements timely.
• Adheres to hybrid work schedule requirements.
• Attends required meetings and town halls.
• Recognizes and communicates ethical and legal concerns through the established channels of communication.
• Demonstrates accountability and responsibility by independently completing work, including projects and assignments on time, and providing timely responses to requests for information.
• Maintains confidentiality at all times.
• Performs other work as requested that is reasonably related to the employee’s position, qualifications, and competencies.

Job Accountabilities

1. Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of PCHP.
2. Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
3. Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and customer requirements. Seeks advice and guidance as needed to ensure proper understanding.

Parkland Community Health Plan (PCHP) prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.