Director, Risk Analytics

Evolent

About The Position

Evolent partners with health plans and providers to achieve better outcomes for people with the most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of a fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture. Our Risk Analytics team offers candidates the opportunity to support the evolution of value-based care across all lines of business by collaborating directly with our health plan partners. We are advocates for creating patient value and demonstrate this by ensuring that our risk-based financial arrangements are equitable and sustainable. We are pioneers in supporting the development of new innovative patient solutions through modeling and insights empowered by data.

Requirements

Bachelor’s degree, preferably with a quantitative major (e.g. actuarial, statistics, operations research, mathematics, economics) or healthcare focus (health administration, epidemiology, public health, biology).
At least 5 years of professional experience in claims-based healthcare analytics with a payer, provider, vendor, managed care, or related healthcare consulting entity.
Extensive knowledge of healthcare claims; specifically, differences between institutional vs professional billing and various sites of care/service.
Previous Experience with healthcare reimbursement methodologies and calculations such as Fee for Service, value-based care approaches, bundled payments, etc.
Advanced or higher proficiency in Microsoft Excel.
Advanced or higher proficiency in SQL or SAS database/statistical programming languages.
Moderate Proficiency in Microsoft PowerPoint.
Knowledge of health insurance financial business cycle, healthcare quality reporting, and benchmarking.
Ability to work in a very fast-paced environment.
Ability to communicate clearly with diverse stakeholders to solve problems; ability to translate between business needs and analytical needs.
Exceptionally strong analytical abilities, with track record of identifying insights from quantitative and qualitative data.
Prior people management experience.
Ability to work independently with limited oversight.
High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router.

Responsibilities

Serve as a leader in the Performance Suite Risk Analytics team at Evolent, primarily focused on leading a team supporting analytics for evaluating financial/quality performance and complex financial reconciliations with our risk-based partnerships.
Partner closely with executives across finance, program innovation, actuarial, and account management.
Serve as a key leader of the analytics partnership with Client, & Product Finance, and Actuarial teams to outline strategic approach for current risk partnerships, various value-based care models and financial/quality/quality-based metrics and provide discovery and product design analytical support.
Serve as strategic owner of our analytics capabilities and processes related to evaluating performance with our capitated risk partnerships including cost & use projections, financial reconciliations, and providing insight into utilization drivers.
Analyze performance capitated performance-based risk partnerships, focusing on cost and use trends, and estimating Evolent’s ability to reduce costs and improve quality.
Assist in the development of budgets and forecasts for each client and packaging key insights for tracking performance.
Lead and facilitate interactions with existing customers in a manner that fosters trust in Evolent’s expertise and a spirit of collaboration, including presenting on cost and use trends during quarterly performance reviews.
Collaborate with internal/external business customers to understand their problems and objectives, solve business questions, and help them to achieve goals by performing statistical analysis, developing analytic models, and creating data reports/dashboards using a variety of performance metrics.
Partner with other analytical, product, and IT leaders in assessing new and existing analytical tools and continuously improving analytical processes.
Manage, mentor, and coach members of the team.
Set clear goals and objectives using metrics to measure performance while holding staff accountable.
Develop models to quantify and articulate value.
Communicate actionable conclusions from analyses to executive internal/external audiences.
Extract, manage, and analyze claims and operational data using industry-standard metrics.