Value Based Care Cost and Utilization Analyst

Carina Health Network•Denver, CO

12d•$85,000 - $105,000•Remote

About The Position

The Cost & Utilization Analyst is responsible for leading the analysis, interpretation, and dissemination of cost and utilization data across Carina Health Network’s partner organizations. The Cost & Utilization Analyst supports efforts to demonstrate the financial performance, efficiency, and impact of value-based care programs within the network. The goal of the position is to inform strategy, identify opportunities to reduce unnecessary costs, improve utilization, enhance shared savings, and maximize the value of care delivered to vulnerable populations served by partners.

Requirements

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; experience with FQHCs or ACOs highly preferred.
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.

Nice To Haves

Master’s preferred
experience with FQHCs or ACOs highly preferred.

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

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