Staff Healthcare Analyst

Abby Care•San Francisco, CA

5d•$180,000 - $220,000•Hybrid

About The Position

Abby Care is seeking a Staff Healthcare Analyst to lead analytics spanning patient risk modeling, clinical outcomes measurement, and the cost and value analysis used to demonstrate the impact of family-led care. This role is the company’s subject matter expert for clinical and health economics analytics. Reporting to the Senior Manager of Data & Analytics, the analyst will set strategy and standards for measuring risk, cost, and outcomes and develop models and studies used by Clinical, Finance, and executive teams in discussions with payors, actuaries, and research partners. The role works closely with Clinical and Health Plan teams and partners with Finance, Engineering, and Product on cross-functional initiatives. It is a full-time, hybrid position based in San Francisco, California.

Requirements

At least 5 years of experience in healthcare or clinical analytics, health economics and outcomes research (HEOR), actuarial analytics, biostatistics, or population health, including direct experience leading analytics for a business or clinical domain.
Advanced SQL and strong proficiency in Python or R, including statistical and predictive/risk modeling.
Hands-on experience analyzing payor medical and pharmacy claims data, with familiarity with claims data structures and standard code sets such as ICD-10, CPT, and NDC.
Direct experience working with health plans, payors, or actuaries, including the ability to participate in methodology discussions and contract conversations.
Demonstrated experience designing and executing health outcomes studies, including publication in peer-reviewed journals and/or presentation at industry conferences.
Deep knowledge of risk adjustment, cost-of-care and ROI methodology, value-based care economics, and clinical quality measurement.
Experience with dbt, Git, cloud data warehouses, and BI platforms.
Excellent communication and stakeholder-management skills, including the ability to explain complex analysis to Finance, Clinical, and leadership stakeholders for use with payors and actuaries.
High standards for data quality, rigor, and documentation.

Nice To Haves

Experience at a value-based care, population health, or risk-bearing healthcare organization, such as a Medicaid MCO or home-based care company.
Background in causal inference, survival analysis, or predictive modeling for clinical or financial risk.
Familiarity with Medicaid, Medicare, or dual-eligible populations and their cost and quality dynamics.
Experience with prior authorization, revenue cycle, or patient lifecycle data.
Familiarity with data requirements of AI or agentic clinical systems.

Responsibilities

Build patient stratification and risk models, including utilization, hospitalization, adverse-event, and acuity-tier models, to inform care prioritization and intervention design.
Own risk adjustment methodology and ensure alignment with payor and regulatory expectations.
Analyze medical and pharmacy claims data to identify utilization patterns, cost drivers, and gaps in care, and to inform and validate risk models.
Lead cost-of-care and ROI analyses, including total cost of care, cost offsets, and medical loss ratio impact, to quantify the value of family-led care.
Structure and analyze value-based care and risk-sharing arrangements, including shared savings, care management fees, and other contract structures.
Develop and validate methodologies, assumptions, and results used by Finance in payor negotiations, actuary discussions, and audit responses.
Design clinical studies with the Clinical team and research health outcomes, following rigorous study design and biostatistics practices.
Own implementation of clinical quality and outcomes measurement, aligned where relevant with industry frameworks such as HEDIS, Stars, and state Medicaid quality measures.
Develop evidence such as case studies, white papers, peer-reviewed publications, and conference presentations to establish Abby Care as a credible, data-backed participant in home-based care.
Partner with Finance to incorporate clinical and health economics analysis into payor contract negotiations and provide evidence on cost offsets, outcomes, and value.
Partner with Clinical, Health Plan, Engineering, and Product teams to define shared metrics, data models, and dashboards for clinical and financial performance.
Establish measurement frameworks with relevant teams for clinical interventions, care protocols, and product and operational experiments.