Lead the financial strategy behind utilization management (UM) and affordability initiatives by designing robust financial models that measure real-world impact. You'll ensure every strategic investment is grounded in accurate, transparent financial analysis and aligned with enterprise-wide savings goals.
Key Responsibilities
- Develop and maintain financial models to assess the projected and actual savings from UM strategies, ensuring consistency with corporate financial pipelines.
- Serve as the primary financial liaison between UM, Medical Economics, and Finance teams, advocating for the visibility and prioritization of UM initiatives.
- Establish a trusted, centralized system for tracking value—monitoring active programs, delivering monthly updates, and refining measurement methodologies to reflect actual performance.
- Collaborate with Data Science and clinical leadership to validate ROI frameworks and translate complex data into clear, actionable insights for executives.
- Design decision-support tools that incorporate risk adjustment and Medical Loss Ratio (MLR) impacts to guide investment choices under uncertainty.
- Ensure compliance with healthcare regulations and support ad hoc strategic analysis as needed.
Qualifications
- Minimum of 4 years in management consulting, financial strategy, or healthcare corporate planning, with at least 3 years focused on financial modeling, cost-benefit analysis, and program delivery.
- Proven experience in ACA Individual and Small Group markets, including how utilization management affects risk adjustment and MLR.
- Background in health insurance, healthcare systems, or healthcare consulting required.
- Advanced skills in SQL and Excel are essential; experience with Looker or similar visualization tools is strongly preferred.
- A Master’s degree is a plus, as is direct experience with actuarial or medical economics functions.
This role supports remote work across multiple states, with occasional travel for team collaboration. Compensation includes a competitive salary range of $105,808–$138,886, annual performance bonuses, equity, and access to comprehensive employee benefits, including an unlimited vacation policy.
