Director, Health Plan Economics

🕒 Abril 10

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Alignment Health

SiteLinkedInTodas as Vagas

501 - 1000 funcionários

Fundada em 2013

⚕️ Seguro de Saúde

👥 B2C

💰 $321.050.000 Post-IPO Debt - Alignment Health em 2024-11

Healthcare Insurance • B2C

A Alignment Health é uma empresa de seguros de saúde focada no Medicare, que oferece planos Medicare Advantage e serviços centrados nos membros. Ela oferece acesso a cuidados 24 horas por dia, 7 dias por semana, por meio de canais presenciais, domiciliares e móveis, e dispõe de um cartão sob demanda no estilo concierge para ajudar os membros a agendar consultas, organizar transporte e responder a perguntas de saúde. A Alignment Health faz parcerias com corretores, prestadores de serviços, Organizações de Cuidados Responsáveis (ACOs) e parceiros institucionais, opera em vários estados dos EUA (incluindo Arizona, Califórnia, Nevada, Carolina do Norte e Texas), e recebeu altas classificações do CMS e reconhecimento no setor.

Descrição

• Develop and maintain risk‑stratification frameworks to identify high‑risk and emerging‑risk members for care management, utilization management, and disease management programs. • Build and refine predictive models for hospitalization, readmissions, ED utilization, progression of chronic disease, and care gap closure. • Translate model outputs into actionable insights for clinical operations, network management, and product teams. • Evaluate medical cost trends with clear decomposition of unit cost, utilization, service mix, and demographic drivers. • Quantify financial risk across populations, benefit designs, provider arrangements, and value‑based care programs. • Conduct deep‑dive analyses into cost containment opportunities, high‑cost cohorts, and avoidable utilization. • Partner with Utilization Management and Clinical Operations to reconcile authorization, admission, and bed‑day data with paid claims; ensure accuracy and consistency of operational metrics. • Lead or participate in cross‑functional governance of measure definitions to align IT, Finance, Clinical, and Operational areas. • Develop predictive KPIs and operational forecasts to support proactive business management. • Prototype data pipelines, dashboards, and analytical tools to support evolving business needs. • Work hands‑on with medical and pharmacy claims data to validate assumptions, troubleshoot anomalies, and uncover business insights. • Promote best practices in data quality, metadata management, and analytic reproducibility. • Lead cross‑functional analytic initiatives, ensuring alignment with organizational strategy and CMS program requirements. • Provide coaching, mentorship, and technical training to analytics staff. • Address performance gaps, support professional development, and uphold team accountability standards.

🎯 Requisitos

• At least 10 years of experience in healthcare analytics, medical economics, actuarial/financial analysis, or a related field. • At least 10 years of managerial experience. • Bachelor of Science in Business required. • Advanced proficiency working with claims (medical, pharmacy) and enrollment data for trend analysis, forecasting, and predictive modeling. • Strong command of predictive modeling tools and statistical methods; SQL required, Python or R strongly preferred. • Deep understanding of CMS Medicare Advantage payment methodologies (RAF, risk adjustment, benchmarks, STARS, etc.). • Familiarity with provider contracting strategies, value‑based care economics, and population health models. • Expertise in risk stratification, utilization patterns, and cost containment strategies. • Demonstrated success leading analytics teams and guiding cross‑functional initiatives. • Ability to translate complex analytical findings into clear, actionable recommendations for senior leaders. • Experience establishing governance, standardization, and best practices across analytics and operational functions.

🏖️ Benefícios

• Health insurance • Retirement plans • Paid time off • Flexible work arrangements • Professional development