AVP, Managed Care Contracting & Medical Economics

Position Summary

This role will lead our Managed Care Contracting & Medical Economics business unit. This department is responsible for conducting quantitative analysis to determine organizational risks of participating in various value-based care programs. In addition, this person will be responsible for engaging with payor partners on negotiating both FFS and value-based arrangements for our provider network affiliates.

Responsibilities

• Apply quantitative analysis to underwrite risk across various value-based care contracts, including but not limited to P4Q, professional fee capitation, two-sided shared savings models, and global capitation arrangements.

• A strong understanding of healthcare terminology and principles, including medical coding, claims data, and broader medical economic trends, including Part A, B, and D segments.

• Strong proficiency in using databases and tools to query, interpret, and build sensitivity models to evaluate risk propensity.

• Ability to take claims data and develop IBNR models to inform a prediction of future paid claims experience.

• Partner cross-functionally with internal stakeholders on legal implications of managed care negotiations, financial forecasting and budgeting, and operational delivery tactics.

• Effective verbal, written, and presentation skills to wide audiences, including physicians, executive management, and external stakeholders.

• Participate in payor JOC meetings to facilitate alignment on performance targets and goals.

Qualifications

• Bachelor’s degree (B.A.) in actuarial science, healthcare economics, quantitative analysis, mathematics, or a closely related field; a statistics background would prove helpful in this role

• Experienced healthcare economist or actuary with a payor or benefits consultant background.

• ASA or FSA designation required, or progress towards such designations.

• Experience in client-facing roles

• Strong analytical abilities and proficiency with Microsoft Office, especially Word, Excel, and PowerPoint.

• Experience across different health insurance products is highly preferred, including: Medicare, Medicaid, commercial, and exchange lines of business.

Location

Miramar, FL (Hybrid or Remote)

Compensation & Benefits

• $150 - 200K base salary compensation. Actual compensation offered to the successful candidate may vary from the posted hiring range based on work experience, skill level, and other factors.

• Health, dental, and vision insurance.

• 401(k)

• Paid time off and company holidays.

• Opportunity to shape the future of healthcare technology within a rapidly growing value-based care organization.