MaxHealth
Vice President, Medical Economics
MaxHealth is seeking a Vice President of Medical Economics to serve as a strategic leader and connector between Analytics, Finance, Operations, and Senior Leadership, ensuring that data-driven insights directly inform financial management, care delivery optimization, and organizational strategy.
This full‑risk, value‑based healthcare organization is committed to delivering exceptional outcomes for our patients and partners. Our SQL‑based enterprise data warehouse integrates data from multiple payers, care delivery systems, and internal operations to drive insight, accuracy, and performance.
This is a hybrid, Florida‑based role with a consistent presence at our Tampa Corporate Office required.
Key Responsibilities
Act as the primary liaison between Finance, Analytics, and Operations to ensure alignment between data insights and financial strategy.
Translate complex analytical findings into actionable financial and operational recommendations for senior leadership.
Partner with clinical, contracting, and operational teams to identify opportunities for cost containment, quality improvement, and risk optimization.
Lead the development and maintenance of medical cost, utilization, and profitability models across lines of business and payers.
Oversee attribution, risk adjustment, and reconciliation processes for full‑risk and shared‑savings arrangements.
Evaluate performance drivers such as inpatient utilization, pharmacy trends, physician efficiency, and referral patterns.
Direct actuarial and forecasting efforts in collaboration with Finance to ensure accuracy in reserves, accruals, and projections.
Manage and interpret complex, service‑fund‑based payer data, including reconciliation of settlements and shared savings.
Lead Medicare Risk Adjustment modeling, ensuring accuracy of RAF projections and alignment with coding, documentation, and encounter submissions.
Support Medicare Advantage bid analysis, revenue forecasting, and financial scenario modeling.
Partner with Contracting on value‑based contracting strategy, contract negotiation, financial terms evaluation, and performance monitoring.
Ensure alignment between data warehouse outputs and financial reporting systems.
Strengthen source‑to‑report traceability and auditability of medical economics data.
Establish review protocols and sign‑off procedures for high‑impact reports and dashboards.
Build and mentor a high‑performing team of medical economics analysts, actuarial specialists, and financial modelers.
Drive a culture of accountability, transparency, and collaboration.
Represent the medical economics function in board‑level and payer‑facing discussions.
Qualifications Education & Experience
Bachelor's degree required; Master's preferred.
10+ years of experience in medical economics, actuarial analysis, or financial analytics in risk‑bearing healthcare.
Deep experience with complex payer service‑fund accounting and settlement workflows.
Extensive Medicare Risk Adjustment experience, including RAF modeling and encounter‑driven analytics.
Demonstrated experience with value‑based contracting, including contract design, financial modeling, and performance measurement.
Experience with Medicare Advantage bid development, rate analysis, and CMS revenue dynamics.
Strong understanding of capitation, risk adjustment, encounter data, and payer reporting.
SQL proficiency and experience validating warehouse‑driven reporting pipelines.
Skills & Attributes
Exceptional analytical and communication skills.
Ability to translate data into clear business narratives.
Strong leadership presence and collaboration mindset.
High attention to data quality, accuracy, and governance.
Compensation & Benefits This healthcare position earns a competitive wage, depending on experience, and provides health benefits, a 401k plan, life insurance, long‑term disability, paid holidays, and PTO.
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This full‑risk, value‑based healthcare organization is committed to delivering exceptional outcomes for our patients and partners. Our SQL‑based enterprise data warehouse integrates data from multiple payers, care delivery systems, and internal operations to drive insight, accuracy, and performance.
This is a hybrid, Florida‑based role with a consistent presence at our Tampa Corporate Office required.
Key Responsibilities
Act as the primary liaison between Finance, Analytics, and Operations to ensure alignment between data insights and financial strategy.
Translate complex analytical findings into actionable financial and operational recommendations for senior leadership.
Partner with clinical, contracting, and operational teams to identify opportunities for cost containment, quality improvement, and risk optimization.
Lead the development and maintenance of medical cost, utilization, and profitability models across lines of business and payers.
Oversee attribution, risk adjustment, and reconciliation processes for full‑risk and shared‑savings arrangements.
Evaluate performance drivers such as inpatient utilization, pharmacy trends, physician efficiency, and referral patterns.
Direct actuarial and forecasting efforts in collaboration with Finance to ensure accuracy in reserves, accruals, and projections.
Manage and interpret complex, service‑fund‑based payer data, including reconciliation of settlements and shared savings.
Lead Medicare Risk Adjustment modeling, ensuring accuracy of RAF projections and alignment with coding, documentation, and encounter submissions.
Support Medicare Advantage bid analysis, revenue forecasting, and financial scenario modeling.
Partner with Contracting on value‑based contracting strategy, contract negotiation, financial terms evaluation, and performance monitoring.
Ensure alignment between data warehouse outputs and financial reporting systems.
Strengthen source‑to‑report traceability and auditability of medical economics data.
Establish review protocols and sign‑off procedures for high‑impact reports and dashboards.
Build and mentor a high‑performing team of medical economics analysts, actuarial specialists, and financial modelers.
Drive a culture of accountability, transparency, and collaboration.
Represent the medical economics function in board‑level and payer‑facing discussions.
Qualifications Education & Experience
Bachelor's degree required; Master's preferred.
10+ years of experience in medical economics, actuarial analysis, or financial analytics in risk‑bearing healthcare.
Deep experience with complex payer service‑fund accounting and settlement workflows.
Extensive Medicare Risk Adjustment experience, including RAF modeling and encounter‑driven analytics.
Demonstrated experience with value‑based contracting, including contract design, financial modeling, and performance measurement.
Experience with Medicare Advantage bid development, rate analysis, and CMS revenue dynamics.
Strong understanding of capitation, risk adjustment, encounter data, and payer reporting.
SQL proficiency and experience validating warehouse‑driven reporting pipelines.
Skills & Attributes
Exceptional analytical and communication skills.
Ability to translate data into clear business narratives.
Strong leadership presence and collaboration mindset.
High attention to data quality, accuracy, and governance.
Compensation & Benefits This healthcare position earns a competitive wage, depending on experience, and provides health benefits, a 401k plan, life insurance, long‑term disability, paid holidays, and PTO.
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