Director, Medical Economics
Position Title: Director, Medical Economics
Reports To: VP, Operational & Bus. Dev. Analytics
Department: Actuarial
Classification: Exempt
Places of Work: Remote
People Leader: No
About the Organization:
Equality Health is an integrated, holistic, and tech-enabled healthcare delivery system focused on improving the health and wellness of diverse populations. Founded in 2015, Equality Health aims to improve access to value-based care for people who have long struggled with navigating the traditional one-size-fits-all U.S. healthcare system. The mission of the company is to provide high-quality care that improves and enhances lives regardless of race, ethnicity, age, or income.
Through its supplemental care management services and proprietary technology platform, CareEmpower™, Equality Health helps managed care plans and health systems improve outcomes and lower costs for diverse populations while simultaneously facilitating the transition to risk-based accountability. Equality Health supports over 800,000 members and more than 4,000 practice sites and continues to scale rapidly.
In 2021, Equality Health partnered with General Atlantic, a leading global growth equity firm, to help drive continued expansion and fuel the next phase of growth as a leading value-based primary care network serving the Medicaid, Medicare and ACA Exchange populations. This strategic investment will enable Equality Health to pursue further geographic expansion, technological innovation and product development while furthering its mission of increasing access to care, lowering costs and improving outcomes for underserved individuals, families and communities.
About the Role:
The Director of Medical Economics will serve as the dedicated analytic partner to the VP, VBC Impact & Strategy. This role will develop the analyses, measurement approaches, and evidence needed to assess Equality Health’s value-based care impact across clinical, financial, operational, quality, utilization, patient, and health-equity outcomes; substantiate Equality Health’s value for payer, provider, and state stakeholders; and inform impact and strategy work.
Working within the Actuarial organization and closely with the VP, VBC Impact & Strategy, this role will translates Impact & Strategy’s questions and priorities into rigorous analytic workplans, conduct or coordinate the supporting analyses, and deliver clear, reliable findings, methods, and exhibits.
The ideal candidate combines strong healthcare economics and analytic skills with intellectual curiosity, sound methodological judgment, and the ability to communicate findings clearly. They are comfortable working with claims, clinical, quality, operational, and financial data; identifying limitations; and partnering closely with a strategy leader to produce credible evidence of impact.
Key Responsibilities
Analytic Support for VBC Impact Assessment
- Partner with the VP, VBC Impact & Strategy to translate analytic plans, data requirements, metrics, and evidence needed to assess Equality Health’s value-based care model impact.
- Develop and execute analyses of clinical, financial, operational, quality, utilization, patient experience, and health-equity performance in support of impact framework.
- Apply appropriate methods for attribution, risk adjustment, benchmarking, trend analysis, cohort comparison, and program evaluation, documenting assumptions and limitations.
- Identify and quantify material drivers of cost, utilization, quality, clinical outcomes, and other performance measures; prepare findings for interpretation and strategic synthesis.
- Support recurring measurement approaches to evaluate impact consistently over time and across stakeholders.
Evidence Development and Synthesis Support
- Develop clear analytic exhibits, summaries, source logic, and supporting materials for payer, provider, state, executive, Board, and growth-facing value materials.
- Prepare analyses tailored to the relevant population, market, payer partner, provider network, or program while maintaining consistent underlying methods.
- Clearly communicate analytic findings, data limitations, methodological caveats, and confidence in conclusions to enable credible external claims.
- Collaborate with Medical Economics, Actuarial, Clinical, Operations, Finance, Product, Network, Growth, and data teams to obtain and reconcile the inputs needed for analyses.
Dedicated Partnership and Delivery
- Maintain a prioritized analytic workplan and delivery cadence for the VP’s VBC Impact & Strategy priorities.
- Support the VP, Impact & Strategy in defining analytic governance, documentation, and reusable measurement standards for ongoing impact evaluation.
- Respond to ad hoc analytic questions and provide timely, decision-ready work products.
- Resolve resourcing, methodology, data, and prioritization decisions.
Measures of Success
- Production of timely, rigorous, and transparent analytical support for assessing and demonstrating Equality Health’s value-based care impact.
- Analyses are credible, reproducible, well-documented, and clear about assumptions and limitations.
- Consistently draw on reliable evidence to tailor value narratives and strategic recommendations to stakeholder needs.
- Cross-functional relationships and analytic inputs are coordinated efficiently, minimizing duplicated work and inconsistent findings.
Qualifications
Required Qualifications
- 7+ years of progressive experience in medical economics, healthcare analytics, actuarial analysis, outcomes research, population health, value-based care, or a related field.
- Strong understanding of VBC programs, healthcare claims, clinical, financial, quality, and operational data and their use in evaluating healthcare performance.
- Past experience with relational databases and statistical programming.
- Experience evaluating healthcare interventions using comparative, longitudinal, or other rigorous program-evaluation methods.
- Mastery of causal inference and quasi-experimental study design.
- Experience with attribution, risk adjustment, benchmarking, trend, program evaluation, and financial impact measurement.
- Demonstrated ability to execute rigorous analyses, explain methods and limitations, and communicate findings to technical and non-technical partners.
- Experience working cross-functionally with clinical, actuarial, finance, analytics, operations, product, network, growth, or commercial teams.
- Bachelor’s degree in economics, statistics, mathematics, public health, health services research, actuarial science, business, data science, or a related discipline.
Leadership Competencies
- Executive influence: Communicates with clarity and credibility and builds alignment across diverse senior internal and external stakeholders.
- Clinical and operational understanding: Appreciates the realities of care delivery and can connect analytical findings to the clinical and operational mechanisms that create value.
- Constructive curiosity: Challenges assumptions, seeks to understand the drivers behind performance, and remains pragmatic and solutions-oriented.
- Cross-functional leadership: Mobilizes teams across organizational boundaries and creates shared accountability for defining, demonstrating, and improving value.
Preferred Qualifications
- Experience with Medicaid managed care and populations, including the clinical, social, operational, and economic dynamics that influence Medicaid outcomes.
Equality Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation,
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