Medical Home Network
Are you ready to join a passionate community of people who are changing how health care is delivered? A place where you will find a career you love while truly making a difference building healthier communities. If this sounds like you, we would love to have you apply as
Director, Actuarial Services , with Medical Home Network!
Since 2009, Medical Home Network (MHN) has partnered with Federally Qualified Health Centers (FQHCs) nationwide to transform care in the safety net, reduce health disparities, and build healthier communities. MHN helps FQHCs succeed in value‑based care through technology, care model innovation, and strong partnerships, delivering leading health outcomes, lower costs, and elevated quality performance.
The Opportunity The Director of Actuarial Services will apply a rigorous analytical approach to value‑based care contracts, focusing on evaluating, managing, and forecasting risk within MHN’s Medicare, Commercial, and Medicaid contracts. The role will develop actuarial models to assess potential financial impacts across performance scenarios and provide input for reporting to internal and external stakeholders. It will also support the development of formal actuarial and economic frameworks for evaluating value‑based care contracts and translate high‑level strategic targets into quantitatively defined risk decision architecture across multiple lines of business. Collaboration with MHN’s Finance, Growth, and Performance teams is integral.
Perks
Fun, challenging, and collaborative work environment with passionate colleagues that care deeply about healthcare delivery.
Recognized as One of the Best Places to Work in Healthcare by Modern Healthcare.
Competitive benefits programs including Medical, Vision, Dental, HSA, FSA, and 401k.
Fitness reimbursement, commuter benefits, and tuition assistance.
Great work‑life benefits—Paid time off, sick time, and 12 paid holidays.
Hybrid schedule: Candidates within 50 miles of Chicago are expected to work onsite 2 days per week and remotely for 3 days. Preference is for a hybrid candidate for this role, but fully remote options are available for candidates located outside this area.
What You Can Look Forward To
Lead actuarial modeling and financial forecasting across CMS programs including MSSP, REACH, Medicare Advantage, and Medicaid value‑based initiatives, ensuring deep alignment with current regulatory and benchmarking methodologies.
Oversee the design and evaluation of value‑based care payment models, including shared savings/loss arrangements, capitation, prospective budgets, and performance incentive programs.
Direct enterprise‑wide risk adjustment strategy for Medicare Advantage, MSSP/ACO REACH, and Medicaid, optimizing coding accuracy, risk capture processes, and prospective RAF forecasting.
Work with contracting team to support contract negotiation including new contracts and contract renewal with shared savings, capitation, and total cost of care models.
Partner with clinical, quality, and coding teams to ensure compliant and effective risk adjustment operations and year‑round performance monitoring.
Develop actuarial analyses supporting network design, provider performance evaluation, incentive structures, and payment model optimization across Medicare Advantage and Medicaid networks.
Manage actuarial analysis for settlements, reconciliations, and ongoing contract performance.
Develop and maintain an actuarial/economic framework for evaluating risk in value‑based care contracts across contracts.
Identify risks and proactively develop and present mitigation recommendations for clinical and performance teams.
Partner with data science and population health teams to enhance predictive models for patient risk stratification and care management targeting.
Interface cross‑functionally and perform analyses to fulfill the requirements of other MHN teams.
Communicate complex actuarial findings clearly to non‑technical stakeholders, including clinicians, executives and external partners.
What You’ll Need To Succeed
Bachelor’s degree in Finance, Economics, Actuarial Sciences, Statistics, Math, or another quantitative field; Master’s degree or other advanced degrees preferred.
8+ years in healthcare with health plans, provider groups, or consulting firms and 5+ years doing healthcare actuarial analyses; experience in value‑based care.
Fellow of the Society of Actuaries (FSA) or Associate of the Society of Actuaries (ASA) designation.
Strong ability to perform data analysis using large healthcare claims and utilization datasets. Skilled in Advanced Excel modeling, with experience in SAS and SQL; familiar with R and Python.
Experience with Word, PowerPoint, and Excel.
Knowledge of standard methods for measuring health care utilization, spending, quality, and outcomes; risk adjustment, provider profiling, and related analytical tasks.
Demonstrated ability to independently lead and execute complex, high‑visibility projects with multiple stakeholders.
Proven track record of creating, maintaining, and enhancing relationships and communicating effectively with senior management.
Intense attention to detail and extraordinary commitment to assurance of data quality and integrity for important work products.
Experience with MA mechanisms and industry structure, including familiarity with STARS, the MA bid process, and the basic economics of the MA market.
Experience functioning in a highly matrixed organization and delivering complex, cross‑functional projects.
Experience developing and applying consistent analytical frameworks to contracts in the value‑based care space.
Experience as an independent contributor in a fast‑changing operational environment of a healthcare startup or similar.
Passionate about driving the shift from fee‑for‑service to value‑based care and securing the future of primary care and federally qualified health centers.
Experience working with projections of premiums, costs, MLR, and other aspects of MA forecasting.
Medical Home Network is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected characteristic. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.
#J-18808-Ljbffr
Director, Actuarial Services , with Medical Home Network!
Since 2009, Medical Home Network (MHN) has partnered with Federally Qualified Health Centers (FQHCs) nationwide to transform care in the safety net, reduce health disparities, and build healthier communities. MHN helps FQHCs succeed in value‑based care through technology, care model innovation, and strong partnerships, delivering leading health outcomes, lower costs, and elevated quality performance.
The Opportunity The Director of Actuarial Services will apply a rigorous analytical approach to value‑based care contracts, focusing on evaluating, managing, and forecasting risk within MHN’s Medicare, Commercial, and Medicaid contracts. The role will develop actuarial models to assess potential financial impacts across performance scenarios and provide input for reporting to internal and external stakeholders. It will also support the development of formal actuarial and economic frameworks for evaluating value‑based care contracts and translate high‑level strategic targets into quantitatively defined risk decision architecture across multiple lines of business. Collaboration with MHN’s Finance, Growth, and Performance teams is integral.
Perks
Fun, challenging, and collaborative work environment with passionate colleagues that care deeply about healthcare delivery.
Recognized as One of the Best Places to Work in Healthcare by Modern Healthcare.
Competitive benefits programs including Medical, Vision, Dental, HSA, FSA, and 401k.
Fitness reimbursement, commuter benefits, and tuition assistance.
Great work‑life benefits—Paid time off, sick time, and 12 paid holidays.
Hybrid schedule: Candidates within 50 miles of Chicago are expected to work onsite 2 days per week and remotely for 3 days. Preference is for a hybrid candidate for this role, but fully remote options are available for candidates located outside this area.
What You Can Look Forward To
Lead actuarial modeling and financial forecasting across CMS programs including MSSP, REACH, Medicare Advantage, and Medicaid value‑based initiatives, ensuring deep alignment with current regulatory and benchmarking methodologies.
Oversee the design and evaluation of value‑based care payment models, including shared savings/loss arrangements, capitation, prospective budgets, and performance incentive programs.
Direct enterprise‑wide risk adjustment strategy for Medicare Advantage, MSSP/ACO REACH, and Medicaid, optimizing coding accuracy, risk capture processes, and prospective RAF forecasting.
Work with contracting team to support contract negotiation including new contracts and contract renewal with shared savings, capitation, and total cost of care models.
Partner with clinical, quality, and coding teams to ensure compliant and effective risk adjustment operations and year‑round performance monitoring.
Develop actuarial analyses supporting network design, provider performance evaluation, incentive structures, and payment model optimization across Medicare Advantage and Medicaid networks.
Manage actuarial analysis for settlements, reconciliations, and ongoing contract performance.
Develop and maintain an actuarial/economic framework for evaluating risk in value‑based care contracts across contracts.
Identify risks and proactively develop and present mitigation recommendations for clinical and performance teams.
Partner with data science and population health teams to enhance predictive models for patient risk stratification and care management targeting.
Interface cross‑functionally and perform analyses to fulfill the requirements of other MHN teams.
Communicate complex actuarial findings clearly to non‑technical stakeholders, including clinicians, executives and external partners.
What You’ll Need To Succeed
Bachelor’s degree in Finance, Economics, Actuarial Sciences, Statistics, Math, or another quantitative field; Master’s degree or other advanced degrees preferred.
8+ years in healthcare with health plans, provider groups, or consulting firms and 5+ years doing healthcare actuarial analyses; experience in value‑based care.
Fellow of the Society of Actuaries (FSA) or Associate of the Society of Actuaries (ASA) designation.
Strong ability to perform data analysis using large healthcare claims and utilization datasets. Skilled in Advanced Excel modeling, with experience in SAS and SQL; familiar with R and Python.
Experience with Word, PowerPoint, and Excel.
Knowledge of standard methods for measuring health care utilization, spending, quality, and outcomes; risk adjustment, provider profiling, and related analytical tasks.
Demonstrated ability to independently lead and execute complex, high‑visibility projects with multiple stakeholders.
Proven track record of creating, maintaining, and enhancing relationships and communicating effectively with senior management.
Intense attention to detail and extraordinary commitment to assurance of data quality and integrity for important work products.
Experience with MA mechanisms and industry structure, including familiarity with STARS, the MA bid process, and the basic economics of the MA market.
Experience functioning in a highly matrixed organization and delivering complex, cross‑functional projects.
Experience developing and applying consistent analytical frameworks to contracts in the value‑based care space.
Experience as an independent contributor in a fast‑changing operational environment of a healthcare startup or similar.
Passionate about driving the shift from fee‑for‑service to value‑based care and securing the future of primary care and federally qualified health centers.
Experience working with projections of premiums, costs, MLR, and other aspects of MA forecasting.
Medical Home Network is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected characteristic. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.
#J-18808-Ljbffr