About the position
The Senior Director of Medical Economics will lead a team accountable for defining, executing, and measuring data-driven clinical strategies to generate a positive return on investment and better patient outcomes for our value-based care programs. This role will analyze healthcare cost and utilization patterns and partner closely with stakeholders across the business to define and operationalize clinical strategies to reduce spend and improve patient outcomes. This role requires expertise in population health, value-based care, and analytic and data science techniques, as well as strong leadership, communication, and cross-functional collaboration. This role will report to the Vice President of Analytics.
Responsibilities
- Lead a team dedicated to analytics, data science and clinical strategies that create positive ROI for the business and improved patient quality and outcomes.
- Engage cross functional team members, including clinical, operational, financial/actuarial, and constituent experience stakeholders, to inform clinical strategies and establish a clinical intervention performance improvement process to achieve our medical cost impact objectives.
- Complete extensive market, utilization and clinical research to ensure comprehensive sourcing and evaluation of opportunities.
- Prioritize initiatives in our clinical intervention roadmap based on established criteria with clear business case ROI performance.
- Evaluate the efficacy of our clinical programs across our populations and networks relative to the resource investment, to ensure a positive return on investment to create value for our business, our provider customers, and our patients.
- Partner with team members to leverage advanced statistical and predictive modeling techniques to identify and stratify at-risk patient populations based on their healthcare needs, enabling proactive interventions and personalized care plans.
- Provide leadership, guidance, and mentorship to the medical economics team.
- Recruit future team members and facilitate career development opportunities.
- Stay abreast of evolving regulatory requirements related to program offerings (Medicare Advantage, MSSP, etc.), population health management and value-based care, ensuring compliance with relevant laws and regulations.
- Continuously monitor industry trends, emerging technologies, and best practices in population health management and value-based care analytics and proactively integrate them into the medical economics team strategy and roadmap.
Requirements
- Advanced degree (e.g., Master's or Ph.D.) in analytics, data science, health informatics, or a related field.
- Extensive experience (10+ years) in healthcare analytics, with a focus on population health management and value-based care.
- Clinical training or experience a plus.
- The ideal candidate has worked previously with a payer, ACO or risk bearing entity.
- Proven track record of driving successful analytics initiatives and achieving measurable outcomes in population health management and value-based care.
- Ability to lead a diverse team to execute on a range of analytics strategies and initiatives and to effectively collaborate with cross-functional teams and resources.
- Ability to hold staff accountable to productivity, quality and financial targets.
- Strong knowledge of healthcare data sources, including electronic health records (EHRs), claims data, and other relevant data sets.
- Proficiency in statistical analysis, predictive modeling, and data science tools and techniques.
- Deep understanding of population health management concepts, risk stratification methodologies, and value-based care reimbursement models.
- Experience with healthcare analytics platforms and technologies, such as data warehouses, business intelligence tools, and machine learning frameworks.
- Strong leadership skills with the ability to effectively communicate complex analytics concepts to diverse audiences, including executive leadership, clinicians, and non-technical stakeholders.
- Excellent problem-solving and critical thinking abilities, with a focus on defining and executing cost-effective enterprise strategies.
- Familiarity with healthcare regulatory and related requirements, such as HIPAA, PHI, HCC, ICD-10, QPP, etc. and a commitment to maintaining data privacy and security.
- Integrity: The right way is the only way.
- Dependability: You do what you say you are going to do.
- Advocacy: You fight for the best possible outcome for providers and their patients.
- Clarity: You make it all understandable.
