Manager, Medical Economics

Summary

Join Stellar Health as a Manager, Medical Economics and contribute to the success of our ACO and value-based risk contracts. You will leverage your analytical skills to drive surplus performance, utilizing standardized medical economics tools and data analysis to identify opportunities and risks. This role involves collaborating with cross-functional teams, creating reports, and advising on study design for impact assessments. You will use your expertise in medical claims data, value-based contracting, and statistical analysis to inform strategic decision-making. The position offers a competitive salary, performance-based bonuses, equity grants, and a comprehensive benefits package.

Requirements

• 6+ years experience working in an analytical role with internal stakeholders to answer business questions
• Experience analyzing and summarizing medical claims data (inclusive of utilization and cost)
• Experience with Value-based contracting design
• Medical economic cost modeling, reporting/trending, and identification of opportunities
• Risk adjustment (MA/MSSP) knowledge
• Strong proficiency in SQL and Excel
• Strong proficiency with one or more BI tools (Tableau, Looker, PowerBI) )for data analysis and visualization
• Experience working in a cloud-based data warehouse environment like Snowflake or Databricks
• Must be able to turn Excel and SQL analyses into usable presentations and memos for consumption across different teams/audiences

Responsibilities

• Using Stellar data, CMS publicly available data and/or purchased data - identify Medical groups that are good targets for Stellar to grow with in our ACO or via other global capitation contracts
• Support negotiations with health plans by identifying key levers of Stellar performance within the contract and creating models to show range of opportunity or risk
• Within the ACO, use claims data to identify potentially attributable patients, patients at-risk of losing attribution
• Work with performance management teams to identify strategies to maintain and/or grow membership
• Create ACO and Medical Group-level reporting showing attribution opportunities and risks
• Create and model impact of risk adjustment accuracy efforts; assist with setting targets where relevant
• Identify areas of potential risk adjustment inaccuracy for Performance & Operations teams
• Project contract financial performance on all relevant contracts (including but not limited to the ACO)
• Identify & report on cost and utilization trends
• Develop standardized views and complete ad hoc analyses to identify high cost patients, disease states, or provider-level views
• Lead Stellar cross-functional Medical Economics committee meeting to review findings and discuss intervention opportunities
• Create standardized Revenue & Cost of Care reporting for Medical Groups, including development & identification of a standard set of "key opportunities" for medical groups
• Analyze clinical interventions to evaluate their impact on patient utilization and cost of care
• Develop and apply methodologies to isolate the effects of interventions, attributing changes in utilization and cost to specific programs or initiatives
• Advise on study design set-up in order to enable sound impact assessments (e.g. preferred method (pre/post vs control/treatment), target sample size, target experiment period, etc.)
• Leverage advanced statistical methods to analyze healthcare data
• Perform hypothesis testing to determine whether observed changes in utilization or cost are statistically significant, providing confidence in results
• Interpret and communicate statistical results, including p-values, confidence intervals, and effect sizes, to key stakeholders

Preferred Qualifications

Actuarial designation

Benefits

• Medical, Dental and Vision Benefits
• Unlimited PTO
• Universal Paid Family Leave
• Company sponsored One Medical memberships and Citibike memberships
• Medical Travel Benefits
• A monthly wellness stipend that gives employees the freedom to choose where they spend their cash, whether it be on wellness, pet care, childcare, WFH items, or charitable donations
• Stock Options & a 401k matching program
• Career development opportunities like Manager Training, coaching, and an internal mobility program
• A broad calendar of company sponsored social events that for our in-office and remote employees
• The salary range for this role is $140,000 - $180,000 and will be eligible for an annual performance based bonus and equity grant