Total Cost of Care Strategy Lead

This is a fully remote position, open to applicants in United States.

📋 Description

• Create and implement frameworks to assess provider performance in terms of total cost of care, clinical quality, and downstream utilization.

• Measure variations among providers to uncover actionable savings opportunities stemming from differences in appropriateness, effectiveness, site of service, unit price, and utilization patterns.

• Formulate methodologies to assess the downstream effects of provider selection on overall healthcare expenditure and member outcomes.

• Convert complex performance and cost dynamics into clear, defensible scoring outputs that are both analytically robust and practically implementable.

• Utilize the total cost of care provider scoring framework to devise benefit strategies (e.g., cost-sharing structures, deductible adjustments).

• Analyze the financial implications of plan modifications at the population level, ensuring that incentive structures are economically viable and aligned with anticipated savings.

• Examine competitors' strategies to identify gaps and potential opportunity areas (forward looking).

• Innovate to foresee and fulfill the needs of prospective clients and the market.

• Collaborate closely with Product, Solution Engineering, Actuarial, and Data teams to guide solution design.

• Work together with market-facing teams on go-to-market initiatives to refine designs that cater to existing client needs and assess opportunities for new clients.

• Perform all other duties as assigned.

⛳️ Requirements

• 5–10+ years of experience in health economics, actuarial analysis, healthcare analytics, or total cost of care modeling.

• Proficient in working with healthcare claims data and conducting cost and utilization modeling.

• Demonstrated experience in constructing value-based models that are operational and utilized for decision-making.

• Background in value-based care and actuarial modeling.

• A strong sense of personal accountability and trustworthiness.

• Commitment to adhering to Quantum Health’s policies, values, and ethics, and safeguarding sensitive data entrusted to us.

• Preferred Qualifications: Experience in provider performance measurement and episode-based cost modeling.

• Familiar with Machine Readable Files (MRF) and understanding of provider attribution and referral patterns.

• Knowledgeable in health economics or actuarial concepts.

🏝️ Benefits

• Health, vision, and dental plans featuring our top-of-the-line healthcare navigation services.

• Life insurance coverage.

• Legal and identity protection services.

• Adoption assistance programs.

• Employee Assistance Program (EAP).

• Teladoc services for virtual healthcare.

• 401(k) plan offering up to a 4% employer match with full vesting on the first day.

• Paid Time Off (PTO).

• 7 paid holidays each year.

• Parental leave benefits.

• Volunteer days to encourage community engagement.

• Paid sabbaticals for long-term employees.

• Tuition reimbursement up to $5,250 annually.

• Reimbursement for certifications and continuing education.

• Discounted partnerships with higher education institutions.

• Paid training and leadership development opportunities.

• Casual dress code promoting comfort.

• Open floor plans enhancing collaboration.

• Full-service dining options available.

• Free snacks and beverages provided.

• Complimentary 24/7 fitness center with group classes.

• Outdoor walking paths for leisure and exercise.

• Game room for relaxation and fun.

• Notary and dry-cleaning services for convenience.