AVP, Medicare Quality Analytics

📋 Description

• • Alignment Health is seeking a visionary Associate Vice President (AVP), Data Science & Analytics – Medicare Quality, to spearhead the strategy and execution of advanced analytics that significantly enhance quality performance within the Star Ratings Program. This pivotal role is designed for a seasoned data scientist with extensive experience in healthcare quality measurement, predictive modeling, and the development of data-driven strategies, aiming to transform the lives of seniors and those with chronic illnesses.
• • As the principal architect of the organization's Star Ratings analytics ecosystem, you will be instrumental in developing sophisticated predictive models, generating crucial actionable insights, and shaping data strategies that directly impact quality outcomes. Your day-to-day responsibilities will encompass leading the design, development, and continuous refinement of advanced statistical and machine learning models to predict and optimize performance on the Star Ratings Program. You will own the technical roadmap for the analytics platform, ensuring its capability to support current and future analytical needs, and translate complex model outputs and datasets into actionable member, provider, and measure-level insights.
• • You will be responsible for the end-to-end development of forecasting models for the Star Ratings Program, including the design of risk-adjusted simulations, and will develop and maintain performance monitoring tools and dashboards to track and measure performance across all organizational levels. A key aspect of this role involves serving as the organization's senior data science subject matter expert on all Star measures, such as HEDIS, CAHPS, HOS, and Part D. You will translate complex CMS methodology into technical data requirements and support regulatory reporting and CMS audit readiness through rigorous data validation.
• • Furthermore, you will act as the primary analytics partner to clinical, quality, and business leaders, guiding them in interpreting data and making informed decisions. This includes presenting complex data science findings and model outcomes to executive audiences, clearly communicating the connection to business objectives and strategic value. You will also lead and mentor a dedicated team of data scientists and analysts, promoting best practices in statistical modeling, coding, data wrangling, and visualization to foster a culture of technical excellence and data-driven inquiry.
• • About the team and company: Alignment Health is dedicated to serving seniors and the chronically ill, committed to a mission of putting the senior first. This fast-growing company offers ample room for growth and innovation, providing an opportunity to do work that truly matters by changing and saving lives.
• • In this role, you can expect to deepen your expertise in healthcare quality analytics, particularly within the Medicare Advantage landscape. You will have the opportunity to shape the strategic direction of data science initiatives, mentor a high-performing team, and make a tangible impact on the health and well-being of a vulnerable population. You will also gain invaluable experience in executive communication and cross-functional leadership within a dynamic healthcare organization.
• • Required: Minimum 10+ years of data science, data engineering, or a related field, with a proven track record of designing and executing large-scale, complex data solutions.
• • Required: Significant experience in a leadership capacity, with demonstrated ability to set technical vision and manage teams.
• • Required: In-depth knowledge of the healthcare industry, specifically Medicare Advantage and the CMS Star Ratings System.
• • Required: Expert-level proficiency with modern data architecture principles, including cloud platforms (Azure), data warehousing, data lakes, and ETL/ELT processes.
• • Required: Demonstrated experience establishing and managing data governance and data quality programs.
• • Required: Strong understanding of data security and compliance requirements in a healthcare context.
• • Required: Bachelor’s degree in Health Informatics, Computer Science, Data Science, Business Analytics or related quantitative field.
• • Required: Healthcare & Stars Domain Knowledge: Understanding of Medicare Advantage, the CMS Star Ratings Program, HEDIS measures, CAHPS/HOS surveys, and pharmacy data (PDE).
• • Required: Advanced Modeling & Statistical Strategy: Ability to direct and apply sophisticated statistical and machine learning methods to solve critical business problems.
• • Required: Analytical Data Architecture & Engineering: Oversight of data preparation, strategic dataset design, advanced feature engineering, and ensuring data integrity.
• • Required: Technical Leadership & Implementation: Expert-level proficiency in Python and advanced SQL, setting and enforcing best practices for coding and analytical rigor.
• • Required: Executive Translation: Ability to distill complex data concepts into clear summaries for non-technical executives.
• • Required: Strategic Thinking: Capacity to develop a long-term vision and roadmap aligned with business objectives and anticipate future regulatory changes.
• • Required: Stakeholder Management & Influence: Proven ability to build consensus and foster strong relationships with diverse stakeholders.
• • Required: Thought Leadership & Mentorship: Ability to lead through influence and mentor technical staff.
• • Required: Problem-Solving: Pragmatic approach to deconstructing complex problems and designing effective technical solutions.
• • Competitive salary range: $149,882.00 - $224,823.00 annually.
• • Opportunity to work remotely within the U.S., with the requirement to align with PST business hours.
• • Comprehensive benefits package and opportunities for professional growth within a mission-driven organization.