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Medical Home Network · 1 month ago

Director, Actuarial Services

180 N Stetson Ave Ste 600-1, Chicago, IL 60601

Full-time

Hybrid

Director/Executive

8+ years exp

Medical Home Network is a mission-driven public benefit corporation focused on transforming care in the safety net and reducing health disparities. The Director of Actuarial Services will apply analytical approaches to value-based care contracts, develop actuarial models, and support risk evaluation and mitigation efforts across all of MHN's contracts.

Health CareHospitalMedicalNon Profit

Responsibilities

Lead actuarial modeling and financial forecasting across CMS programs including MSSP, REACH, Medicare Advantage, and Medicaid value-based initiatives, ensuring deep alignment with current regulatory and benchmarking methodologies

Oversee the design and evaluation of value-based care payment models, including shared savings/loss arrangements, capitation, prospective budgets, and performance incentive programs

Direct enterprise-wide risk adjustment strategy for Medicare Advantage, MSSP/ACO REACH, and Medicaid, optimizing coding accuracy, risk capture processes, and prospective RAF forecasting

Work with contracting team to support contract negotiation including new contracts and contract renewal including shared savings, capitation, and total cost of care models

Partner with clinical, quality, and coding teams to ensure compliant and effective risk adjustment operations and year-round performance monitoring

Develop actuarial analyses supporting network design, provider performance evaluation, incentive structures, and payment model optimization across Medicare Advantage and Medicaid networks

Manage actuarial analysis for settlements, reconciliations, and ongoing contract performance

Develop and maintain an actuarial/economic framework for evaluating risk in value-based care contracts across contracts

Identify risks and proactively develop and present mitigation recommendations for clinical and performance teams

Partner with data science and population health teams to enhance predictive models for patient risk stratification and care management targeting

Interface cross-functionally and perform analyses to fulfill the requirements of other MHN teams

Communicate complex actuarial findings clearly to non-technical stakeholders, including clinicians, executives and external partners

Qualification

Actuarial modelingFinancial forecastingValue-based careData analysisFellow of the Society of ActuariesAdvanced Excel modelingSASSQLCommunication skillsAttention to detailProject managementRelationship building

Required

Bachelor's degree in Finance, Economics, Actuarial Sciences, Statistics, Math or another quantitative field

8+ years in healthcare with health plans, provider groups or consulting firms and 5+ years doing healthcare actuarial analyses; experience in value-based care

Fellow of the Society of Actuaries (FSA) or Associate of the Society of Actuaries (ASA) designation

Strong ability to perform data analysis using large healthcare claims and utilization datasets

Skilled in Advanced Excel modeling, with experience in SAS and SQL; familiar with R and Python

Experience with Word, PowerPoint, and Excel

Knowledge of standard methods for measuring health care utilization, spending, quality, and outcomes; risk adjustment, provider profiling, and related analytical tasks

Demonstrated ability to independently lead and execute complex, high-visibility projects with multiple stakeholders

Proven track record of creating, maintaining, and enhancing relationships and communicating effectively with senior management

Intense attention to detail and extraordinary commitment to assurance of data quality and integrity for important work products

Experience with MA mechanisms and industry structure, including familiarity with STARS, the MA bid process, and the basic economics of the MA market

Experience functioning in a highly matrixed organization and delivering complex, cross-functional projects

Experience developing and applying consistent analytical frameworks to contracts in the value-based care space

Experience as an independent contributor in a fast-changing operational environment of a healthcare startup or similar

Passionate about driving the shift from fee-for-service to value-based care and securing the future of primary care and federally qualified health centers

Experience working with projections of premiums, costs, MLR, and other aspects of MA forecasting