AVP, Managed Care Contracting & Medical Economics

Responsibilities

• Apply quantitative analysis to underwrite risk across various value-based care contracts, including but not limited to P4Q, professional fee capitation, two-sided shared savings models, and global capitation arrangements.
• A strong understanding of healthcare terminology and principles, including medical coding, claims data, and broader medical economic trends, including Part A, B, and D segments.
• Strong proficiency in being able to use databases and tools to query, interpret, and build sensitivity models to evaluate risk propensity.
• Ability to take claims data and develop IBNR models to inform a prediction of future paid claims experience.
• Partner cross-functionally with internal stakeholders on legal implications of managed care negotiations, financial forecasting and budgeting, and operational delivery tactics.
• Effective verbal, written, and presentation skills to wide audiences, including physicians, executive management, and external stakeholders.
• Responsible for participating in payor JOC meetings to facilitate alignment on performance targets and goals.

Requirements

• Bachelor's degree (B.A.) in actuarial science, healthcare economics, quantitative analysis, mathematics, or a closely related field; a statistics background would prove helpful in this role
• Experienced healthcare economist or actuary with a payor or benefits consultant background.
• ASA or FSA designation required, or progress towards such designations.
• Experience in client-facing roles
• Strong analytical abilities and proficiency with Microsoft Office, especially Word, Excel, and PowerPoint.
• Experience across different health insurance products is highly preferred, including: Medicare, Medicaid, commercial, and exchange lines of business.
• Location: Miramar, FL (Hybrid or Remote)
• Compensation & Benefits
• $150 - 200K base salary compensation. Actual compensation offered to the successful candidate may vary from the posted hiring range based on work experience, skill level, and other factors.
• Health, dental, and vision insurance.
• 401(k)
• Paid time off and company holidays.
• Opportunity to shape the future of healthcare technology within a rapidly growing value-based care organization.

Benefits

Additional Information

Salud Healthcare Salud Healthcare is transforming the delivery of value-based care by empowering provider organizations with data-driven insights, modern technology, and operational excellence. As a rapidly growing Management Services Organization (MSO), Salud partners with physician groups to improve patient outcomes, optimize clinical performance, and navigate the complexities of value-based care. Our technology platform serves as the connective tissue between providers, payers, analytics, and operations-helping healthcare organizations close care gaps, improve quality outcomes, and drive better financial performance. We are building the next generation of healthcare applications that power population health management, risk adjustment, care coordination, analytics, and provider engagement. Position Summary This role will lead our Managed Care Contracting & Medical Economics business unit. This department is responsible for conducting quantitative analysis to determine organizational risks of participating in various value-based care programs. In addition, this person will be responsible for engaging with payor partners on negotiating both FFS and value-based arrangements for our provider network affiliates.

Your Match

How well this role fits your profile.

Company Intel

What employees say

Worked at triedge-investments? Share your experience