The Senior Financial Analyst - Value-Based Care supports the financial performance, analysis, and strategy of risk-based contracts across Medicaid, Medicare Advantage and Commercial managed care populations in a safety net hospital setting. This role is critical in evaluating capitation, shared savings/loss arrangements, and incentive programs, including partnerships with Managed Care Organizations (MCOs), Independent Practice Associations (IPAs), and Physician-Hospital Organizations (PHOs). This role will contribute to the development/refinement of the overall hospital system and its employed provider group financial strategies.
The analyst will translate complex claims, clinical, social risk and revenue cycle data into actionable financial insights to support system-wide margin optimization, care model optimization, and long-term value-based transformation.
Key Job Activities: VBC Financial Performance- Analyzes financial performance of managed care contracts (all payor types), including capitation, shared savings/loss, quality withholds, and incentive programs.
- Monitors Medical Loss Ratio (MLR), total cost of care (TCOC), and contribution margin across Medicaid populations.
- Evaluates impact of risk adjustment (e.g., CDPS, HCC variants) on revenue and contract performance.
- Supports reconciliation and settlement processes with MCOs. • Works with Sinai Chicago's third party actuary.
Utilization & Cost Driver Analysis- Identifies key cost drivers in populations, including ED utilization, avoidable admissions, post-acute spend, and pharmacy trends. • Analyzes high-cost, high-need populations, including dual-eligible and complex chronic cohorts.
- Assesses the financial impact of care management, behavioral health integration, and SDOH interventions.
- Applies utilization and cost driver analyses to support Sinai Chicago service line(s) development. sinaichicago.org Modeling & Forecasting
- Develops financial models to forecast MCO population performance under varying risk and rate scenarios • Models impact of rate changes, acuity shifts, and attribution changes on revenue and margin
- Supports scenario planning for downside risk readiness and capital exposure
- Connects modeling and forecasting analyses with Sinai Chicago's overall system priorities in all areas, e.g. inpatient capacity, ambulatory growth, specialty access and care transformation all with an eye towards margin growth and/or margin sustainability.
Managed Care Contracting Support Analyzes managed care contract terms, including but not limited to:
- Capitation rate structures
- Risk corridors and stop-loss provisions
- Quality incentive structures and withholds
- Provides financial insights to support payer negotiations and contract strategy.
- Evaluates performance variation across MCOs and recommends optimization strategies.
Cross-Functional Collaboration- Partners with Sinai Chicago's finance, revenue cycle management, population health, care management, and clinical leadership to align financial and operational strategies.
- Supports PHO/IPA governance structures with financial reporting and insights.
- Contributes to strategic initiatives focused on reducing disparities and improving outcomes in underserved populations.
- Performs other duties as assigned.
Education and work Experience:- Bachelor's degree in Finance, Accounting, Economics, Healthcare Administration, or related field (Master's preferred)
- 7+ years of healthcare financial analysis experience
- Direct experience with: Medicaid, Medicare Advantage and Commercial managed care programs IPAs, PHOs, or safety net delivery systems Value-based care or risk-based contracting
- Experience with below is preferred: • Hospital finance and employed medical group finance, including service line performance, margin analysis, departmental budgeting, labor productivity, volume trends and capital planning, provider productivity with RVUs, access capacity management and volume management sinaichicago.org
- Hospital and provider group revenue cycle management
- Experience in Illinois Medicaid programs (e.g., MCO models, D-SNP, former MMAI or successor programs) preferred
- Exposure to dual-eligible populations and integrated care models preferred.
- Experience supporting ACOs or Medicaid value-based arrangements with downside risk preferred
- Background working in or with FQHCs, community-based providers, or urban safety net hospitals preferred
