Total Cost of Care Strategy Lead

🕒 June 20

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Quantum Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1999

🏥 Healthcare

⚕️ Healthcare Insurance

💳 Fintech

💰 Private Equity Round on 2020-11

Healthcare • Healthcare Insurance • Fintech

Quantum Health is a healthcare navigation company that simplifies the healthcare experience by providing comprehensive care solutions and personalized member support. The company focuses on improving clinical and financial outcomes for its clients by guiding members to quality care and optimizing health benefits. With a tech-empowered approach, Quantum Health uses real-time technology to proactively engage members and ensure a smooth healthcare journey, ultimately delivering significant cost savings and enhanced satisfaction for both employees and employers.

📋 Description

• Design and implement frameworks that evaluate provider performance across total cost of care, clinical quality, and downstream utilization • Quantify variation across providers to identify actionable savings opportunities driven by differences in appropriateness, effectiveness, site of service, unit price, and utilization patterns • Develop methodologies to evaluate the downstream impact of provider selection on overall healthcare spend and member outcomes • Translate complex performance and cost dynamics into clear, defensible scoring outputs that are both analytically rigorous and practically actionable • Apply the total cost of care provider scoring framework to develop benefit strategies (e.g., cost-sharing structures, deductible shifts) • Evaluate financial impact of plan changes at the population level and ensure that incentive structures are economically sustainable and aligned to expected savings • Look at what our competitors are doing and identify gaps and opportunity areas (forward looking) • Innovate to anticipate and meet needs of prospective clients/the market • Partner closely with Product, Solution Engineering, Actuarial, and Data teams to inform solution design • Collaborate with market-facing teams on GTM initiatives to refine design to meet the needs of existing clients and to evaluate opportunities for prospective clients • All other duties as assigned

🎯 Requirements

• 5–10+ years health economics, actuarial analysis, healthcare analytics, or total cost of care modeling • Experience working with healthcare claims data and cost and utilization modeling • Experience building value-based models that are deployed in production and used for decision-making • Experience in value-based care and actuarial modeling • A high degree of personal accountability and trustworthiness • A commitment to working within Quantum Health’s policies, values and ethics, and to protecting the sensitive data entrusted to us • Preferred Qualifications: Experience in provider performance measurement and episode-based cost modeling • Familiarity with Machine Readable Files (MRF) and provider attribution and referral patterns • Background in health economics or actuarial concepts

🏖️ Benefits

• Health, vision and dental featuring our best-in-class healthcare navigation services • Life insurance • Legal and identity protection • Adoption assistance • EAP • Teladoc services • 401(k) plan with up to 4% employer match and full vesting on day one • Paid Time Off (PTO) • 7 paid holidays • Parental leave • Volunteer days • Paid sabbaticals • Tuition reimbursement up to $5,250 annually • Certification/continuing education reimbursement • Discounted higher education partnerships • Paid trainings and leadership development • Casual dress code • Open floor plans • Full-service dining • Free snacks and drinks • Complimentary 24/7 fitness center with group classes • Outdoor walking paths • Game room • Notary and dry-cleaning services