Sr. Manager, APM Modeling & Analytics

Arcadia

5d•Remote

About The Position

Arcadia is dedicated to happier, healthier days for all. We believe that there is a better healthcare world â one powered by data. Our platform transforms complex, diverse data into a unified foundation for health, helping organizations deliver better care, boost revenue, and lower costs. Weâre a team of fiercely driven individuals committed to making healthcare more sustainableâand weâre looking for passionate people to help us get there. For more information, visit arcadia.io Why This Role Is Important to Arcadia Arcadia is expanding its leadership in advanced alternative payment models (APMs), including CMSâ newly announced LEAD Model and other value-based initiatives. This role will report directly to the Chief Actuary, and serve as the enterprise owner of APM solutions, ensuring technical rigor and financial accuracy across our most strategic engagements. You will not simply advise on strategy â you will own the math. This includes full accountability for: CMS APM (e.g., LEAD, TEAM, ACCESS, MSSP) solution development and implementation CMS data (e.g., VRDC, CCLF, BCDA) ingestion and execution Independent validation and quality controls This role requires deep understanding of CMS and other VBC models, expertise working with CMS data (e.g., VRDC, CCLF, BCDA), strong coding skills (e.g., SAS, Python, SQL), exceptional attention to detail in building and validating complex financial models at scale, and leadership in establishing and enforcing validation and quality assurance controls. What Success Looks Like In 3 months Develop deep working knowledge of CMS LEAD model methodology and financial mechanics Contribute to Arcadiaâs market communications on the CMS LEAD model (e.g., whitepaper, customer discussions) Gain hands-on access to VRDC data sources and Arcadiaâs data ingestion processes Understand existing Arcadia APM calculation logic and identify improvement opportunities Establish coding standards and validation protocols for actuarial model governance In 6 months Develop CMS LEAD model financial calculations and underwriting framework in collaboration with actuaries Fully own other existing Arcadia CMS APM solutions (e.g., MSSP) Serve as the internal subject matter expert for CMS APM financial modeling Build reproducible, well-documented SAS and Python pipelines for: Customer data ingestion Benchmark construction Risk score development and normalization Trend and PMPM projections Savings/loss simulations Implement multi-layer QA processes and reconciliation procedures In 12 months Deliver production-ready, validated CMS LEAD model outputs to clients Be recognized as Arcadiaâs enterprise leader for APM financial modeling Establish formal governance for underwriting assumptions and change control Drive measurable financial accuracy and performance improvement across engagements Influence product roadmap to ensure actuarial precision is embedded in platform design

Requirements

Bachelor's Degree in related Data Science, Actuarial Science, Finance, Economics or related field
Minimum of 6 years of healthcare experience, with a focus on CMS APMs, value-based contracting and analytics
Strong accountability, intellectual curiosity, and customer satisfaction mindset
Experience modeling and evaluating key financial parameters within value-based contracts for health plan or provider
Experience with database querying (SAS, SQL, Python), Amazon Quick Site or BI Tool equivalent

Nice To Haves

Actuarial experience or experience supporting actuaries with CMS/CMMI Models (LEAD, TEAM, ACCESS, MSSP, etc.)
Consulting experience with deadline-driven project management accountability and effective communication of complex, technical topics to health plan or provider stakeholders
Hands on experience developing and overseeing product roadmap related to VRDC assets

Responsibilities

APM Model Ownership
Own end-to-end financial modeling for CMS LEAD and other APMs
Translate CMS technical specifications into production-grade actuarial models
Develop and maintain benchmark, attribution, risk adjustment, and reconciliation logic
Ensure integrity of actuarial inputs (e.g., underwriting methodology, pricing assumptions) in value-based contract modeling
Identify model vulnerabilities and proactively mitigate financial exposure
CMS VRDC & Other Data Technical Execution
Work directly with CMS VRDC data environments to extract, structure, and analyze Medicare claims and enrollment data
Write production-level SAS and Python code to:
Process large claims datasets
Facilitate risk-adjustments
Calculate, risk adjust, and project PMPM benchmarks
Run sensitivity testing
Conduct reconciliation and true-up calculations
Ensure compliance with CMS methodological guidance
Validate data integrity prior to model production
Quality & Validation Leadership
Establish independent validation standards and ensure consistent adherence to these standards across the enterprise
Create automated testing scripts and exception reporting to implement validation checks, parallel runs, and reconciliation frameworks
Maintain version control, documentation, and auditability of all models at a sufficiently robust level to enable audits or CMS review

Benefits

Opportunity to lead Arcadiaâs most high-profile client partnerships, influencing the direction of our actuarial strategy and product innovation
A seat at the table with Arcadiaâs executive leadership, shaping the future of value-based care analytics in the U.S.
Direct access to one of the industryâs largest and most comprehensive healthcare data assets to support groundbreaking actuarial work
A mission-driven culture with the agility of a tech company and the stability of a market leader
A flexible, remote friendly company with personality and heart
Employee driven programs and initiatives for personal and professional development
Be a member of the Arcadian and Barkadian Community

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