Full-Time

Lead Actuarial Consultant

Risk Adjustment

Confirmed live in the last 24 hours

Neuehealth

Neuehealth

201-500 employees

Transforms healthcare with value-based care solutions

Data & Analytics
Healthcare

Senior, Expert

Remote in USA

Preferred locations for applicants will be FL, TX, MN.

Category
Insurance
Risk Management
Finance & Banking
Required Skills
SQL
Databricks
Data Analysis
Excel/Numbers/Sheets
Requirements
  • Bachelor’s degree required in Math, Statistics, Economics, Actuarial Science, or a related field
  • 8+ years of actuarial experience with 5+ years working within healthcare
  • 3+ years working with a CMS/HHS HCC risk adjustment modeling is required
  • 2+ years working with a CMMI ACO Model (of any kind) is strongly preferred
  • 2+ years working with individual/small group ACA rate filings or Medicare Advantage bids is preferred
  • Working knowledge of the CMMI Direct Contracting or Accountable Care Organization (ACO) program(s)
  • Working knowledge of industry value-based contracts between payers and providers (risk sharing arrangements)
  • Experience leading projects and ownership of deliverables
  • Proficient in Microsoft Excel (VBA, advanced data visualization, etc.) and other Office products
  • Experience with forecasting, modeling, SQL (Databricks experience is a plus)
  • Experience with SAS based tools (CMS risk adjustment models)
  • Understanding of company practices related to management of member populations for purposes of estimating risk
  • Produce, understand, and interpret internal and external analysis and reports; provide effective technical and non-technical support to internal and external stakeholders
  • Associate of the Society of Actuaries is required.
Responsibilities
  • Build, maintain, and own the CMS HCC risk scoring model with appropriate data filtering logic. The model will be reliant on FFS claims data provided by CMS for our ACOs participating in ACO REACH and MSSP (not MAO4s / MMRs). An Analytic/IT team would be at your disposal for data and tool build-up.
  • Lead quarterly risk adjustment analysis and forecasting for the Medicare Advantage and Medicare ACO populations. The individual commercial risk adjustment forecasting may become in-scope in the future.
  • Document and present summary review memos in support of the quarterly risk adjustment analysis and forecasting process in preparation for, and as follow up to, collaboration with various NeueHealth, owned clinics and leaders
  • Lead the evaluation of risk adjustment related financial implications of provider participation in networks for ACO REACH / MSSP opportunities
  • Lead provider risk contract evaluations and ACO REACH / MSSP performance evaluations, interfacing with internal Bright team and external consulting actuaries.
  • Collaborate with Operation Risk Adjustment team in the development of forecasting models, projections and relevant information to inform C-Level business decisions – related to Operational coding improvement activities.
  • Perform ad-hoc data analysis using Excel, SAS, SQL (Databricks)
  • Other duties and responsibilities as assigned.

NeueHealth focuses on transforming healthcare through value-based care, which improves patient outcomes while reducing costs. The company provides services like Care Management and Population Health Management to healthcare providers and payors, enhancing clinical performance and simplifying administrative tasks. By modernizing back-office functions and utilizing advanced analytics, NeueHealth allows providers to prioritize patient care. Their goal is to lead the shift to value-based care, benefiting providers, payors, and patients alike.

Company Stage

IPO

Total Funding

$1.5B

Headquarters

Minneapolis, Minnesota

Founded

N/A

Growth & Insights
Headcount

6 month growth

-8%

1 year growth

-36%

2 year growth

-57%
Simplify Jobs

Simplify's Take

What believers are saying

  • NeueHealth's transparent partnership model ensures mutual benefits for providers and payors, fostering long-term relationships and stability.
  • The company's innovative solutions in care management and population health management can lead to significant improvements in patient outcomes and cost savings.
  • Recent financial moves, such as securing a $60M credit facility, indicate strong financial health and the ability to support ongoing operations and growth.

What critics are saying

  • The transition from volume-based to value-based care can be challenging and may face resistance from traditional healthcare providers.
  • The competitive landscape in healthcare technology is intense, with many players vying for market share, which could impact NeueHealth's growth.

What makes Neuehealth unique

  • NeueHealth's focus on value-based care sets it apart from traditional volume-based care models, emphasizing quality over quantity.
  • Their advanced population health technology provides actionable insights, giving them a competitive edge in improving patient outcomes and operational efficiency.
  • The company's modernized administrative services reduce complexity and allow healthcare providers to focus more on patient care, unlike competitors who may still rely on outdated back-office functions.

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