Vice President, Medical Economics

ArchWell Health is a new, innovative healthcare provider devoted to improving the lives of our senior members. We deliver best-in-class care at comfortable, accessible neighborhood clinics where seniors can feel at home and become part of a vibrant, wellness-focused community. Our members experience greater continuity of care, as well as the comfort of knowing they will be treated with respect by people who genuinely care about them, their families, and their communities. 

Job Summary:

ArchWell Health is looking for a Vice President, Medical Economics, to join our team. The primary focuses for this role will include: 1) Partner with leadership to spearhead ongoing operational performance tracking and monitoring; Premium and Revenue trend analysis; 2) Trend of clinical utilization and medical costs to facilitate the responsible use of resources and efficient medical cost management; 3) Medical Group Operations performance analysis and performance monitoring; 4) Translate advanced business analytics problems into technical approaches that yield actionable recommendations in diverse domains (product development, marketing research, supply chain, technology industrial process, and public policy).

Duties/Responsibilities:

• Sets vision and drives tactical execution to design and optimize performance reporting and performance management tools and processes.
• Monitor trends, reviewing financial reporting activities consisting of reserving, risk pool and health plan financial statements, managed care contracting support, and aiding in the development of financial forecast models and assumptions
• Assist the operations, clinical, finance, payor contracting, and IT teams with data analysis and modeling
• Surface comprehensive risk pool performance insights and partner with P&L owners to determine action plans
• Design and build tools to help in trend projections, forecasting, Value-Based Care modeling, and Medicare Advantage bid creation
• Support executive leadership to drive strong clinical and operational performance management and operating discipline to align clinical and operational performance with budget and forecast expectations
• Design and partner with the data team to build clinical, practice management, revenue, and medical cost KPIs, reporting, and insights
• Design and partner with the data team to build claim analysis data tools and different financial and outcomes metrics to provide recommendations
• Partner with cross-functional clinical and operational teams to develop strategies and value initiatives and interventions in financial terms to assist in prioritizing resource allocation and initiatives.
• Directs the team to design, implement, educate, and share the reports, tools, and insights needed for markets to reduce medical costs, provide VIP service, and deliver better health for our seniors.
• Oversees creation and improvement of monthly KPIs for market and executive leadership. Analysis to identify opportunities for medical cost savings across member health risk populations, providers, payors, lines of business, and other attributes.
• Builds relationships with market leadership and internal subject matter experts (network, clinical, operations, etc.) to facilitate the design of cost-efficient initiatives.
• Supervises analysis of the impact of current programs and proposed interventions to understand ROI, share best practices, and forecast performance.
• Supports local market and central finance team in monthly cost projections and yearly budget and strategic planning process with key analytics on medical expense saving inputs and trends in clinical utilization.

Education/Experience:

• Bachelor's Degree in Actuarial Science, Mathematics, Statistics, Finance, Engineering, or other quantitative fields.
• Working knowledge of databases, SAS, and/or SQL preferred
• Ten years of experience directly related work experience required
• Five years of prior leadership experience required
• Prior experience with Medicare Advantage risk contract financial analysis required
• Experience conducting analyses and presenting outcomes to all levels of leadership

ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.