Manager, Medical Economics

About the Position:

This role is critical to creating the underlying business intelligence, performance measurement and target setting for Stellar Health’s ACO and all value-based risk contracts. This hire will work and collaborate closely with ACO Leadership, risk adjustment and quality experts, and provider performance management teams. 

The Manager, Medical Economics will help drive overall surplus performance in Stellar’s ACO and Payor Risk Contracts by utilizing standardized medical economics tools (e.g. Milliman Insights) to determine performance needs in major functional areas (total cost of care, quality, risk adjustment, AWV completion), drilling down to understand provider/region specific opportunities as well as trends and communicating with key stakeholders to support their generation of performance management strategies and measurement of impact.

This is an exciting individual contributor role where you’ll get to lead & execute analyses across the breadth of Value-based Care levers and insights. 

What You’ll Do

Growth Analytics: 

• 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 

Attribution & Risk Adjustment Accuracy Analytics: 

• 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

Medical Economics
Using standardized medical claims data & industry-standard tooling (such as Milliman Insights): 

• 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
• Conduct Impact Assessment:
  
  • 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.
• Statistical Analysis:
  
  • 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

As an ACO Analytics Manager, you should have:

• 6 years experience working in an analytical role with internal stakeholders to answer business questions
• Actuarial designation preferred, but not required
• 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

Who Will Love this Job:

• You have a deep passion for empowering the goals of value-based care in the primary care environment
• You have experience understanding and explaining population health trends, and want to be part of a solution that creates highly actionable insights for providers
• You are an analytics expert but can work cross-functionally with leadership, product and finance
• You get things done and you love working in a dynamic environment; we move quickly and we need a teammate who will too
• You are highly analytical, can structure unstructured problems and work messy data effectively, and can push consistently toward an answer under uncertainty

Pay:

The salary range for this role is $140,000 - $180,000 and will be eligible for an annual performance based bonus and equity grant. Where a new hire falls within this range will be based on their individual skills and experience, and how these competencies compare across other employees in the same role. Stellar's bands are designed to allow for individual compensation growth within the role.  As such, new hires typically start at the lower end of the range.  Stellar rewards performance and outcomes - should you join the company, you will have the opportunity to grow your salary over time.

Stellar reserves the right to change our compensation bands at any time.

Salary : $140,000 - $180,000