VP of Medical Economics

Daymark Health•Boston, MA

About The Position

Daymark Health is a value-based oncology company redefining the cancer care experience for patients, providers, and health plans. Daymark’s comprehensive, personalized cancer care platform empowers patients with dedicated care navigation, symptom-focused support, behavioral health care, and social resources. Combined with evidence-based health interventions and a hybrid in-person + virtual care model, Daymark is improving the overall cancer experience for patients, providers, and health plans – and setting a new standard in cancer care. As Daymark's first VP of Medical Economics, you'll be the first dedicated medical economics hire, sitting on the senior leadership team. You'll own the full cost-of-care analytics function, building everything from payer-facing savings dashboards to internal utilization reporting on top of Daymark's Tuva data infrastructure. Core responsibilities span four areas: contract performance analytics (including shared savings calculations, baseline construction, and serving as Daymark's primary analytical counterpart to health plan actuarial teams), savings initiative modeling (across drug episode groupers, clinical pathway adherence, biosimilar conversion, weight-based dosing, and site-of-care shifts), payer growth support (including opportunity assessments, contract term design, and defending methodology in negotiations), and AI and advanced analytics (leading the medical economics AI strategy and building agentic workflows for claims analytics and EHR monitoring). The role starts as a hands-on individual contributor with a mandate to build out the team over time, ideal for someone who can operate at the analytical and strategic level simultaneously.

Requirements

First dedicated medical economics hire
Sitting on the senior leadership team
Own the full cost-of-care analytics function
Building payer-facing savings dashboards
Building internal utilization reporting
Operating at the analytical and strategic level simultaneously
Hands-on individual contributor role initially
Mandate to build out the team over time
Experience with PMPM, utilization, and service grouper categories
Experience developing shared savings calculations, baseline and trend construction, and member mix and service mix adjustment approaches
Experience normalizing costs across cancer types and acuity cohorts
Experience leading reporting with payer partners
Experience serving as an analytical counterpart to plan medical economics and actuarial teams
Experience designing and maintaining claims-based drug episode groupers
Experience building the analytical foundation for clinical pathway guidelines
Experience developing provider-level adherence benchmarks
Experience building utilization analytics to identify biosimilar conversion opportunities
Experience developing claims-based proxies and patient-level BSA-to-HCPCS unit reconciliation
Experience modeling the financial impact of site-of-care shifts
Experience building and owning internal and external reporting stacks
Experience collaborating with Product and Engineering on data model and agentic workflow development
Experience leading AI strategy for medical economics
Experience identifying high-value use cases for LLM and agentic workflows
Experience building AI tooling infrastructure
Experience developing agentic EHR monitoring workflows
Experience supporting claims-based opportunity assessments for new payer partnerships
Experience supporting contract term design
Experience serving as an analytical voice in payer negotiations
Experience building and leading a function
Experience collaborating with an actuary team
Experience serving as an SLT member

Nice To Haves

Pioneer in transforming cancer care (referring to CEO, but implies company culture)
Value-based oncology company experience
Experience with oncology drug portfolio
Experience with EHR data

Responsibilities

Own total cost-of-care analytics across all payer contracts, including PMPM, utilization, and service grouper categories on top of Tuva infrastructure.
Develop shared savings calculations, baseline and trend construction, and member mix and service mix adjustment approaches that normalize costs across cancer types and acuity cohorts, ensuring adjustments are transparent, reproducible, and defensible to plan counterparts.
Lead reporting with payer partners and serve as Daymark's primary analytical counterpart to plan medical economics and actuarial teams.
Design and maintain claims-based drug episode groupers attributing spend by cancer type, line of therapy, and regimen to enable consistent cross-provider and cross-payer comparisons.
Build the analytical foundation for Daymark's clinical pathway guidelines, defining evidence-based, cost-efficient regimen standards by cancer type, line of therapy, and patient cohort; develop provider-level adherence benchmarks that identify outlier prescribing patterns and inform pathway refinement.
Build utilization analytics to identify biosimilar conversion opportunities across the oncology drug portfolio; quantify per-episode and savings potential and track adoption against benchmarks.
Develop claims-based proxies and, where EHR data is available, patient-level BSA-to-HCPCS unit reconciliation to flag overdosing and reduce within-type unit costs.
Model the financial impact of site-of-care shifts (hospital outpatient to physician office; office to home infusion) and track migration.
Build and own Daymark's internal and external reporting stack, from payer-facing savings dashboards to internal trend and utilization reports.
Collaborate with Product and Engineering on data model and agentic workflow development to support medical economics and reporting infrastructure.
Lead Daymark's medical economics AI strategy, identifying high-value use cases for LLM and agentic workflows in claims analytics and reporting automation.
Build AI tooling infrastructure and develop agentic EHR monitoring workflows to support proactive care pathway identification.
Support claims-based opportunity assessments for new payer partnerships, including cost and utilization benchmarking and savings lever identification.
Support contract term design, including performance guarantee structure, baseline methodology, and savings-sharing mechanics.
Serve as Daymark's analytical voice in payer negotiations, defending savings estimates, attribution methodology, and other term requirements.
Build and lead the medical economics and reporting function, operating initially as a hands-on individual contributor while developing the hiring roadmap and team structure.
Collaborate with Daymark's actuary team on modeling, trending, and actuarial review.
Serve as an SLT member with a voice in product, clinical, and growth strategy decisions.