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 and optimize our operations.

• Ability to present areas of opportunity to all areas of the organization, including operations, clinical, and finance.
   

Desired skills and experience:

• Actuarial credential (ASA or FSA) is a big plus, but not required

• Broad understanding of managed care business and financial principles such as underwriting, risk adjustment, medical management, physician reimbursement, and risk management.

• Experience extracting and analyzing healthcare claims data directly; experience working with programming languages such as SQL, R and/or Python is a plus.

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Salary Range: Commensurate with experience

Our ranges are purposefully broad to allow for growth within the role over time. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered may depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

• Employer sponsored health, dental and vision plan with low or no premium

• Generous paid time off

• $100 monthly mobile or internet stipend

• Stock options for all employees

• Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles

• Parental leave program

• 401K program

• And more....

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

Healthcare equality is at the center of Devoted’s mission to treat our members like family.  We are committed to a diverse and vibrant workforce. 

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.