Director of Health Plan Economics

Job Summary

A company is looking for a Director of Health Plan Economics.

Key Responsibilities

• Develop and maintain risk stratification frameworks for care management and disease management programs
• Build predictive models for hospitalization and care gap closure, translating insights into actionable recommendations
• Lead and mentor a high-performing analytics team while overseeing cross-functional governance of measure definitions

Required Qualifications

• Minimum of 10 years of experience in healthcare analytics or related fields
• At least 10 years of managerial experience
• Bachelor of Science in Business required
• Advanced proficiency with medical and pharmacy claims data and predictive modeling tools; SQL required, Python or R preferred
• Deep understanding of CMS Medicare Advantage payment methodologies and value-based care economics