Senior Medical Economics Consultant

Support pricing validation, reconciliation modeling, and performance evaluation analyses
Construct prospective and retrospective target-setting methodologies using difference-in-differences approaches, market benchmarking, credibility weighting, and risk-adjusted baselines
Evaluate financial and quality performance across Commercial, Medicare Advantage, and Medicaid lines of business
Develop and operationalize predictive models for cost, utilization, quality outcomes, and performance evaluation
Support steerage, network optimization, and care management analytics
Perform medical cost trend decomposition (unit cost vs. utilization vs. intensity vs. mix)
Conduct risk-adjusted PMPM analysis across specialties, site-of-service, and population segments
Analyze longitudinal performance across defined assessment periods
Quantify impact of specialty utilization patterns and referral dynamics
Evaluating acuity, case-mix, and coding impacts across populations
Write advanced SQL queries to construct episode-level, provider-level, and member-month datasets
Position Requirements:
Bachelor's degree in a STEM field, with Master s degree preferred, or equivalent work experience
5+ years of experience working within a payer or provider organization, or with healthcare analytics or care management organizations
Demonstrated experience across Commercial, Medicare (including MA), and Medicaid populations
Deep experience working the following types of data:
Medical claims data
Enrollment and eligibility data
Provider data
CMS revenue and risk adjustment data
Value-based performance datasets
Strong proficiency in SQL, Tableau, and Excel