We believe no one should navigate healthcare alone.
Total Cost of Care Strategy Lead
Location
United States
Posted
21 hours ago
Salary
0
Seniority
Senior
Job Description
Total Cost of Care Strategy Lead
Quantum Health
• Design and implement frameworks that evaluate provider performance across total cost of care, clinical quality, and downstream utilization • Quantify variation across providers to identify actionable savings opportunities driven by differences in appropriateness, effectiveness, site of service, unit price, and utilization patterns • Develop methodologies to evaluate the downstream impact of provider selection on overall healthcare spend and member outcomes • Translate complex performance and cost dynamics into clear, defensible scoring outputs that are both analytically rigorous and practically actionable • Apply the total cost of care provider scoring framework to develop benefit strategies (e.g., cost-sharing structures, deductible shifts) • Evaluate financial impact of plan changes at the population level and ensure that incentive structures are economically sustainable and aligned to expected savings • Look at what our competitors are doing and identify gaps and opportunity areas (forward looking) • Innovate to anticipate and meet needs of prospective clients/the market • Partner closely with Product, Solution Engineering, Actuarial, and Data teams to inform solution design • Collaborate with market-facing teams on GTM initiatives to refine design to meet the needs of existing clients and to evaluate opportunities for prospective clients • All other duties as assigned
Job Requirements
- 5–10+ years health economics, actuarial analysis, healthcare analytics, or total cost of care modeling
- Experience working with healthcare claims data and cost and utilization modeling
- Experience building value-based models that are deployed in production and used for decision-making
- Experience in value-based care and actuarial modeling
- A high degree of personal accountability and trustworthiness
- A commitment to working within Quantum Health’s policies, values and ethics, and to protecting the sensitive data entrusted to us
- Preferred Qualifications: Experience in provider performance measurement and episode-based cost modeling
- Familiarity with Machine Readable Files (MRF) and provider attribution and referral patterns
- Background in health economics or actuarial concepts
Benefits
- Health, vision and dental featuring our best-in-class healthcare navigation services
- Life insurance
- Legal and identity protection
- Adoption assistance
- EAP
- Teladoc services
- 401(k) plan with up to 4% employer match and full vesting on day one
- Paid Time Off (PTO)
- 7 paid holidays
- Parental leave
- Volunteer days
- Paid sabbaticals
- Tuition reimbursement up to $5,250 annually
- Certification/continuing education reimbursement
- Discounted higher education partnerships
- Paid trainings and leadership development
- Casual dress code
- Open floor plans
- Full-service dining
- Free snacks and drinks
- Complimentary 24/7 fitness center with group classes
- Outdoor walking paths
- Game room
- Notary and dry-cleaning services
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