VP Medical Economics
We are seeking a strategic and highly skilled Vice President of Medical Economics with deep expertise in Accountable Care Organizations (ACO), Value-Based Care (VBC) models, SQL, and actuarial principles. This individual will lead the organization's efforts in optimizing cost-effective care delivery, financial performance, and patient outcomes under value-based care programs. The VP will manage large-scale healthcare programs, utilizing SQL for data analysis and actuarial insights to drive evidence-based decisions, ensure regulatory compliance, and maximize financial performance.
Key Responsibilities:
ACO & VBC Program Leadership:
Lead the strategic direction of ACO and VBC programs, ensuring alignment with organizational goals and achieving key financial and clinical outcomes. Oversee the management and performance of ACO contracts, including cost savings, quality improvement, and risk mitigation.Medical Economics Strategy Development:
Develop and execute strategies to enhance value-based care initiatives, focusing on improving healthcare outcomes and reducing costs. Implement models that optimize financial performance, risk management, and patient care for populations under ACO or VBC arrangements.Data Analysis & SQL Expertise:
Utilize SQL and other analytical tools to extract and analyze large healthcare datasets to drive key decision-making. Develop and refine data models to assess cost drivers, predict trends, and identify opportunities for clinical and financial improvements. Ensure that actionable insights are derived from data and communicated effectively to leadership.Actuarial Expertise & Financial Modeling:
Leverage actuarial knowledge and methodologies to build financial models, estimate risk, and forecast healthcare costs for populations enrolled in ACO or VBC programs. Work closely with the actuarial team to develop pricing strategies, evaluate medical loss ratios, and assess financial outcomes under risk-based contracts.Risk Management:
Lead risk analysis and management efforts to ensure the organization's value-based care programs are financially sustainable. Identify and mitigate risks related to cost, quality, and patient outcomes, and collaborate with clinical teams to ensure that risk-sharing arrangements are effectively managed.Cross-Functional Collaboration:
Partner with clinical, operational, and IT teams to ensure seamless integration of medical economics strategies with day-to-day operations. Work closely with senior management to set goals, monitor performance, and refine strategies.Regulatory Compliance & Industry Standards:
Stay current on regulations and industry trends related to ACOs, VBC, and healthcare economics. Ensure compliance with federal, state, and CMS guidelines, and proactively adapt to changes in healthcare policy that impact financial and operational performance.Leadership & Team Development:
Lead, mentor, and develop a team of medical economics professionals, data analysts, and actuarial staff. Foster a culture of continuous learning, collaboration, and high performance to ensure the team delivers on key objectives.Stakeholder Reporting & Communication:
Prepare and present reports on ACO and VBC program performance, financial outcomes, and forecasts to senior leadership. Effectively communicate complex actuarial and data-driven insights to non-technical stakeholders and external partners.
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