VP Medical Economics

Position Overview

We are seeking a Vice President of Medical Economics to lead the organization's medical cost analytics and performance strategy. This executive will oversee the analysis of healthcare claims, utilization, risk, and provider performance to identify opportunities to improve financial and clinical outcomes across Medicare and value-based populations.

The VP will serve as a strategic partner to executive leadership, Finance, Actuarial, Clinical, Network, and Operations teams, translating complex healthcare data into clear strategies around medical cost management, population performance, and growth.

Key Responsibilities

• Own the medical economics strategy, including medical cost, utilization, trend, and population performance analytics.
• Lead analysis of medical and pharmacy claims to identify emerging cost drivers and opportunities to improve performance.
• Monitor key metrics including PMPM cost, admissions, ER utilization, readmissions, length of stay, specialist utilization, pharmacy spend, and site-of-service trends.
• Lead development of medical cost forecasts, budgets, trend assumptions, and financial performance analyses.
• Evaluate performance across Medicare Advantage, value-based care, and other risk-based populations.
• Partner with Actuarial and Finance on forecasting, reserving, risk adjustment, and financial planning.
• Work closely with clinical and network leadership to identify actionable opportunities at the market, provider group, physician, and patient population levels.
• Evaluate provider performance, referral patterns, network efficiency, and variation in cost and utilization.
• Develop executive dashboards and reporting that translate complex analyses into clear business recommendations.
• Provide analytical support for value-based contracts, shared savings arrangements, capitation, and other risk-bearing models.
• Build and lead a high-performing medical economics team, including analysts, managers, and directors.
• Establish scalable analytical processes, methodologies, and reporting standards as the organization grows.
• Present findings and strategic recommendations to senior executives and other key stakeholders.

Qualifications

• 10+ years of healthcare analytics, medical economics, actuarial, healthcare finance, or related experience, with progressive leadership responsibility.
• Strong experience within a health plan, Medicare Advantage organization, ACO, MSO, risk-bearing provider group, or value-based care organization.
• Deep understanding of healthcare claims, medical cost trends, utilization, reimbursement, provider performance, and healthcare economics.
• Experience with Medicare Advantage and value-based care strongly preferred.
• Demonstrated experience developing medical cost forecasts and identifying actionable cost-of-care opportunities.
• Experience leading analytical teams and developing managers and individual contributors.
• Strong executive communication skills with the ability to turn complex analytics into concise recommendations.
• Working knowledge of SQL and healthcare data environments, with experience using tools such as Power BI, Tableau, SAS, Python, or similar platforms.
• Bachelor's degree in economics, finance, mathematics, statistics, actuarial science, healthcare administration, or another quantitative discipline. Advanced degree preferred.