Total Cost of Care Strategy Lead

About the role

We are seeking a Total Cost of Care Strategy Lead to drive savings by optimizing the relationship between quality and total cost of care. This role will develop and apply models that evaluate cost drivers including site of service, unit price, and utilization.

Essential Responsibilities

• 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, Utilization patters, Referral behavior.
• 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 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.
• Collaborate 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.

Qualifications

• 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 and 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; possibly a credentialed actuary.