Director, Health Plan Economics

🕒 April 10

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Alignment Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2013

⚕️ Healthcare Insurance

👥 B2C

💰 $321.1M Post-IPO Debt - Alignment Health on 2024-11

Healthcare Insurance • B2C

Alignment Health is a Medicare-focused health insurance company that offers Medicare Advantage plans and member-centered services. It provides 24/7 on-demand access to care via in-person, in-home, and mobile channels and features a concierge-style on-demand card to help members schedule appointments, arrange transportation, and answer health questions. Alignment Health partners with brokers, providers, Accountable Care Organizations (ACOs), and institutional partners, operates in multiple U. S. states (including Arizona, California, Nevada, North Carolina, and Texas), and has earned high CMS ratings and industry recognition.

📋 Description

• 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.

🎯 Requirements

• 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.

🏖️ Benefits

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