Director Healthcare Economics – ACO REACH - CINQCARE

Why CINQCARE is Different

CINQCARE is a provider-led, community-based health and care partner dedicated to improving the health and well-being of those who need care the most, with a deep commitment to Black and Brown communities. Our local physicians, nurses, and caregivers work together to serve people and the communities they live in, beyond just treating symptoms. We remove barriers by delivering personalized care as close to home as possible, often in-home, because we know a deep understanding of our Family Members’ race, culture, and environment is critical to delivering improved health outcomes. By empowering Family Members, providers, and caregivers with the support they need, we strive to make health and care a reality—not a burden—every single day. Join us in creating a better way to care.

About You

The Director Healthcare Economics should have the following qualifications:

• Education:
  • Bachelor’s degree in economics, statistics, mathematics, actuarial science, or a related field, OR 8+ years of equivalent experience in healthcare economics. Master's degree in economics, statistics, finance, business, or health administration or related field (preferred).
• Experience:
  • 8+ years of years of Medicare-related experience with payer, provider or value-based contracting. ACO REACH experience preferred.
  • Excellent computer skills required with advanced level of proficiency with Microsoft Office applications including Word, Excel, PowerPoint, and Outlook.
  • Willingness to explore and learn new or unfamiliar applications and databases, and when prepared to teach practices and team members how to maximize technology.
  • Knowledge of statistical software and other analytic software and programming languages.
• Entrepreneurial: CINQCARE seeks to fix gaps that have persisted for generations in the delivery of care to Black and Brown populations. This position is accountable for ensuring CINQCARE is positioned to innovatively deliver on its promise.
• Communication: Excellent verbal, written communication, presentation, and data visualization skills; ability to clearly articulate and present concepts and models in an accessible manner to CINQCARE’s team, investors, partners, and other stakeholders.
• Knowledge and Skills:
  • Proficiency with SQL, SAS and/or other data management programs
  • Proficiency with query tools, database platforms, data mapping/ETL, system platforms and software packages platforms (preferred)
  • Experience working in an Enterprise Data Warehouse environment or multiple source data warehouse
  • Master's degree in economics, statistics, finance, business, or health administration or related field (preferred)
  • Medicaid experience (preferred)
  • Problem solving and critical thinking skills.
  • Excellent attention to detail
  • Effective public speaking skills and data visualization skills
  • Desire to work in a fast-paced, dynamic environment.

• Relationships: Ability to build and effectively manage relationships with business leaders and external constituents.
• Culture: Good judgement, impeccable ethics, and a strong team player; desire to succeed and grow in a fast-paced, demanding, and entrepreneurial Company

About the Job

The Director Healthcare Economics is accountable for providing support and consultation to local markets as well as national leaders related to clinical, financial, utilization, and actuarial reporting related to CINQCARE’s ACO and value-based care initiatives. The Director, Healthcare Economics reports to the SVP Healthcare Economics and Analytics, CINQCARE with accountability for providing strategy, judgment, organization, and evidenced-based analysis to influence decisions, and directly to meet CINQCARE’s requirements. The Director should embody CINQCARE’s core values, including Trusted, Empathetic, Committed, Humble, Creative and Community-Minded.

Primary Responsibilities

The Director Healthcare Economics will have the following responsibilities:

• Responsible for data analytics and reporting in support of trend identification, program development, and program validation related to revenue, cost, utilization, and quality.
• Assess trends and variables impacting ACO performance and produce various reports, presentations, and dashboards communicating performance and associated issues and opportunities.
• Prepare market and business intelligence reports related to value-based care.
• Responsible for financial reporting activities including pro formas, budgets, cash flow reporting, profit and loss statements, and forecasts
• Perform quantitative and qualitative research on topics relating to finance and programmatic matters impacting value-based care programs and opportunities.
• Conduct ad hoc analyses which require comparing, merging, validating, and summarizing multiple and or large data sets for tracking and presenting solutions for identified business problems.
• Manage interactions and data submissions with the CMS Innovation Center 4i system and interaction with CMS on related matters.
• Collaborate with practices participating in CINQCARE ACOs on matters related to areas of responsibility.
• Support cross-functional teams to review, analyze, interpret, document, and communicate details of value-based care arrangements with providers.
• Develops full understanding of value levers and sets performance goals and KPIs.
• Collect, interpret, and analyze historical claims, premium, capitation, and membership data in support of healthcare analyses.
• Understand clinical indicators and appropriate data used to model and evaluate the efficacy and effectiveness of targeted interventions/programs.
• Work with cross-functional teams to proactively identify areas of opportunity to drive improved economic, health and humanistic outcomes related to programs.
• Stay current with updates on technology tools and available data sets relevant to programs of interest to CINQCARE and the use of various analytic techniques.
• Support change management for existing processes and assist in the development of standard processes.
• Works with internal teams to translate reporting needs into the production environment.
• Provide ongoing communications on project status, results, and conclusions.
• Solve complex problems and develop innovative solutions with minimal oversight.
• Act as a subject matter expert

General Duties

The Director Healthcare Economics shall have following duties:

• Leadership: The Director Healthcare Economics will lead in defining and executing strategies and solutions to create business value in the ACO and value-based care areas, including building a team to design, develop, and execute those strategies and solutions to deliver desired outcomes.
• Strategy: The Director Healthcare Economics will establish the business strategy and roadmap: (1) improve outcomes for CINQCARE members; (2) enhance the efficacy of other CINQCARECARE business divisions; and (3) develop and deliver external market opportunities for CINQCARE Care products and services. In establishing the business strategy, the Director Healthcare Economics will define and innovate sustainable revenue models to drive profitability of the Company.
• Collaboration: The Director Healthcare Economics will ensure that healthcare economics capabilities form a cohesive offering, including by working closely with other business divisions to learn their needs, internalize their knowledge, and define solutions to achieve the business objectives of CINQCARE.
• Knowledge: The Director Healthcare Economics will provide subject matter expertise in data-based analysis and solutions.
• Culture: The Director Healthcare Economics is accountable for maintaining a productive, collaborative, safe and inclusive work environment for the team and as part of the larger Company

CINQCARE provides all employees working an average of 30+ hours/week with the option to enroll in healthcare benefits. The cost of healthcare is shared between the company and the employee.

The working environment and physical requirements of the job include:

This position requires both in-home and office-based work. In-office work is performed indoors in a traditional office setting with conditioned air, artificial light, and an open workspace.

In this position you will need the ability to communicate with customers, vendors, management, and other co-workers in person and over devices, sometimes with people who are agitated. Regular use of the telephone and e-mail for communication is essential. Sitting for extended periods is common. Must be able to receive ordinary information and to prepare or inspect documents. Lifting of up to 30 lbs. occasionally may be required. Good manual dexterity for the use of common office equipment such as computer terminals, calculator, copiers, and FAX machines. Good reasoning ability is important. Able to understand and utilize management reports, memos, and other documents to conduct business.