Director, Medical Economics/Medical Expense Actuary

At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States.  And we've just started. So join us on this mission!

Job Description

A bit more about this role: 

The Director of Medical Economics will play a pivotal role in driving enterprise-wide cost improvement initiatives within the organization collaborating with cross-functional stakeholders to identify opportunities for cost optimization while maintaining the highest standards of quality and patient care. This leader will work closely with various areas of the business (eg., market leadership, payment integrity and claims, network, engineering, Devoted Medical), the actuarial team, and executive leadership to inform and drive key operational and strategic decisions.  The Director will possess a strong background in healthcare economics, data analysis, and strategic planning, coupled with a deep understanding of healthcare delivery systems and reimbursement models, as well as an intellectual curiosity and passion to move the business forward and drive results. 

Responsibilities will include:

• Develop and implement cross-functional, strategic initiatives to improve medical cost and quality, including but not limited to provider reimbursement strategies, utilization management programs, and value-based payment models.

• Conduct in-depth analyses of healthcare utilization patterns, cost drivers, and performance metrics to identify areas for improvement and cost savings opportunities.

• Collaborate closely with internal stakeholders, including but not limited to clinical leadership, actuarial, accounting, finance operations, operations, network management, and local market teams, to develop, execute, track, and management strategies aligned with organizational goals and objectives.

• Utilize analytical techniques, in collaboration with the finance, network, and/or data science teams, to forecast and evaluate the financial impact of proposed initiatives and interventions.

• Monitor and evaluate the effectiveness of implemented initiatives through ongoing performance tracking and analysis, and make data-driven recommendations for adjustments and improvements as needed.

• Stay abreast of industry trends, regulatory changes, and best practices in healthcare economics and medical cost management, and incorporate relevant insights into strategic planning and decision-making processes.

• Serve as a subject matter expert on medical economics and cost management matters, providing guidance and support to internal stakeholders and external partners as needed.

• Prepare and present regular reports and presentations to senior and executive leadership on the status of cost improvement initiatives, key performance indicators, and financial outcomes.
   

Required skills and experience:

• 10+ years of Medicare Advantage experience, especially including experience with medical expenses and medical economics.

• Maintain the highest ethical standards at all times, to include maintaining the confidentiality of financial and other sensitive information consistent with moral, professional, and regulatory requirements.

• Must be analytical, hands on, and able to be a leader and contributor on day one.

• Excellent communication and interpersonal skills, with the ability to effectively engage and collaborate with diverse stakeholders at all levels of the organization.

• Strong functional expertise with an understanding of the key financial drivers of Medicare Advantage health plan operations.

• Deep understanding of healthcare delivery systems, payment methodologies, and regulatory frameworks, with a focus on managed care and health insurance operations.

• Strategic ability to understand the business at large and connect mathematical and financial relationships across the organization.

• Ability to operate in an ambiguous, high growth start-up environment where everyday we try to develop an