Note: The job is a remote job and is open to candidates in USA. Evolent partners with health plans and providers to improve outcomes for people with complex and costly health conditions through value-based care. The Director, Risk Analytics will lead analytics for financial and quality performance evaluation, complex reconciliations, modeling, forecasting, and utilization insights across risk-based partnerships while managing and mentoring a team.
Responsibilities
- Key leader of the analytics partnership with Client, & Product Finance, and Actuarial teams to outline strategic approach for current risk partnerships, various value-based care models and financial/quality/quality-based metrics and provide discovery and product design analytical support
- Serving as strategic owner of our analytics capabilities and processes related to evaluating performance with our capitated risk partnerships including cost & use projections, financial reconciliations, and providing insight into utilization drivers
- Analyze performance capitated performance-based risk partnerships, focusing on cost and use trends, and estimating Evolent’s ability to reduce costs and improve quality
- Assisting in the development of budgets and forecasts for each client and packaging key insights for tracking performance
- Leading and facilitating interactions with existing customers in a manner that fosters trust in Evolent’s expertise and a spirit of collaboration, including presenting on cost and use trends during quarterly performance reviews
- Collaborating with internal/external business customers to understand their problems and objectives, solve business questions, and help them to achieve goals by performing statistical analysis, developing analytic models, and creating data reports/dashboards using a variety of performance metrics
- Partnering with other analytical, product, and IT leaders in assessing new and existing analytical tools and continuously improving analytical processes
- Managing, mentoring, and coaching members of the team
- Setting clear goals and objectives using metrics to measure performance while holding staff accountable
- Develop models to quantify and articulate value
- Communicate actionable conclusions from analyses to executive internal/external audiences
- Extract, manage, and analyze claims and operational data using industry-standard metrics
Skills
- • Bachelor's degree, preferably with a quantitative major (e.g. actuarial, statistics, operations research, mathematics, economics) or healthcare focus (health administration, epidemiology, public health, biology)
- • At least 5 years of professional experience in claims-based healthcare analytics with a payer, provider, vendor, managed care, or related healthcare consulting entity
- • Extensive knowledge of healthcare claims; specifically, differences between institutional vs professional billing and various sites of care/service
- • Previous Experience with healthcare reimbursement methodologies and calculations such as Fee for Service, value-based care approaches, bundled payments, etc
- • Advanced or higher proficiency in Microsoft Excel
- • Advanced or higher proficiency in SQL or SAS database/statistical programming languages
- • Moderate Proficiency in Microsoft PowerPoint
- • Knowledge of health insurance financial business cycle, healthcare quality reporting, and benchmarking
- • Ability to work in a very fast-paced environment
- • Ability to communicate clearly with diverse stakeholders to solve problems; ability to translate between business needs and analytical needs
- • Exceptionally strong analytical abilities, with track record of identifying insights from quantitative and qualitative data
- • Prior people management experience
- • Ability to work independently with limited oversight
- We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router
Benefits
- Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done.
- Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees.
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