Carina Health Network · 1 month ago
Value Based Care Cost and Utilization Analyst
Denver, CO
Full-time
Onsite
Mid, Senior Level
3+ years expCarina Health Network is a mission-driven organization focused on transforming community health in Colorado. The Value Based Care Cost and Utilization Analyst will lead the analysis and reporting of cost and utilization data to improve patient outcomes and inform strategy within the network's value-based care programs.
Government Administration
Responsibilities
Apply quantitative and qualitative methods to evaluate cost, utilization, population health, and program performance
Conduct in-depth analyses of total cost of care (TCOC) by CHC, provider, and patient, identifying high-cost beneficiaries, frequent ED utilizers, and drivers of inappropriate utilization, utilizing claims, EHR, HIE data, and other data feeds
Perform leakage and out-of-network spend analyses; assess pharmacy costs, low-value care, and other key cost drivers
Prepare monthly expected vs. actual spend reports, including variance and trend analysis and present findings to a variety of audiences
Monitor and forecast shared savings performance across contracts, including in-depth analysis for CHCs above expected spend
Correlate HCC and RAF scores with cost and performance metrics; identify gaps in diagnosis recapture and coding accuracy
Analyze attribution patterns (e.g., MSSP, new patient growth, unengaged attributed patients) and identify opportunities for improved engagement
Evaluate the financial impact of performance improvement initiatives and provide actionable recommendations to support strategy and profitability
Partner with Business Intelligence to design dashboards and scorecards (e.g., ED use, inpatient admissions, readmissions, post-acute utilization, out-of-network spend, pharmacy costs) for both internal and external stakeholder use
Translate analytic results into clear narratives and actionable insights for diverse audiences, using plain language when presenting to non-technical stakeholders
Collaborate with internal teams, CHC leadership, payors, and technology partners to align analyses with strategic and operational needs
Support dissemination of findings through presentations, reports, publications, and conferences
Develop subject matter expertise in third party population health solutions to extract, analyze, and interpret cost and utilization data for value-based care initiatives
Participate in the planning and design of evaluation frameworks to ensure rigor and alignment with best practices
Support business development activities including product evaluations, demonstrations, and presentations
Share best practices and facilitate collaboration across Carina partner organizations
Attend relevant training, meetings, and conferences to stay current and support professional growth
Influence organizational strategy and annual goals by providing insights and recommendations based on data-driven observations
Qualification
Required
Bachelor's degree in Health Economics, Finance, Statistics, Actuarial Science, Public Health, or related field of study
3–5+ years of experience in healthcare cost analysis, population health analytics, or value-based care analytics
Strong proficiency in data analytics tools (SQL, Tableau, Power BI, Excel, R/Python)
Deep understanding of TCOC, shared savings programs, HCC/RAF scoring, HEDIS/quality metrics, MSSP attribution, and population health management
Ability to interpret complex datasets and translate findings into actionable recommendations
Excellent communication and collaboration skills across clinical, operational, and financial teams
Strong organizational skills with the ability to manage multiple projects and meet deadlines
Flexible, independent, and self-motivated with high accountability
Ability to work remotely with periodic travel as needed
Preferred
Master's preferred
Experience with FQHCs or ACOs highly preferred
Benefits
Insured group health, dental, and vison plans (Employer covers 100% of the cost for dental and vision)
Medical and dependent care flexible spending account options
Employer contributions $900 annually towards a Health Reimbursement Employer (HRA) or Health Savings Account (HSA), depending on the health plan selected
401k retirement plan with up to a 4% employer contribution match
100% employer-paid life, AD&D, short-term, and long-term disability plans paid for employees
Free 24/7 access to confidential resources through an employee assistance program (EAP)
Voluntary benefit plans to complement health care coverage, including accident insurance, critical illness, and hospital indemnity coverage
17 days of paid vacation within one year of service
12 paid sick days accrued by one year of service
14 paid holidays (which includes two floating holidays)
One paid volunteer day
Employer-paid programs/courses for professional growth and development
Cell phone and internet reimbursement
Competitive salary and full benefits
Annual, all expenses paid staff retreat
Flexible work (remote or hybrid)
Supportive, mission-driven team
Opportunities to learn and grow
Company
Carina Health Network
Carina Health Network is a unified care network and trusted partner that delivers innovative solutions, advanced data infrastructure, and expert support to empower community healthcare organizations across Colorado.
11-50 employees
Funding
Current Stage
Early StageCompany data provided by crunchbase