Senior Value-Based Care Modeler

Sr. Value-Based Care Modeler

Enlace Health delivers the only end-to-end solution that solves the infrastructure challenges driving today’s unsustainable healthcare system. Connecting payers, providers, and patients, Enlace™ empowers any type of healthcare delivery model, from facilitating retrospective programs to enabling risk for prospective programs. Combining executive-level healthcare DNA with an extensible technology platform, Enlace is the bridge from chaotic healthcare to the healthcare world when Triple Aim optimization is truly realized.

At Enlace Health, our people are our greatest asset. Our culture is founded upon integrity, hard work, and the relentless pursuit to make a difference. We think creatively, we like a challenge and draw inspiration from each other. As the Sr. Value-Based Care Modeler, you would be responsible for the development, efficiency and effectiveness of advanced VBC models including but not limited to: bundled payment models, pay for performance, shared risk, and full risk models, customized development, and episodes of care. This person will work closely with Enlace Health leadership to align with strategic objectives and initiatives to provide VBC design for effective business decisions and innovative approaches to VBC models. The Sr. VBC Modeler will serve as a liaison to business leaders, internal analytics and customer- facing teams.

Responsibilities:

• Assist in development of the overall conceptualization, strategy alignment, and high-level design of new value-based reimbursement models, based on deep understanding and knowledge of trends with both government and private payers. Programs will include but not be limited to pay-for-value programs, episode payments, prospective bundled payments, gain share and risk share models with the goal of maximizing quality while reducing healthcare costs.
• Maintain knowledge of new developments in both the public and private reimbursement space, including new innovative models developed by CMS to ensure alignment and best in class strategic planning.
• Serve as a resource for the organization on issues related to value-based reimbursement, including impact to organizational strategic efforts or new programs. 
• Subject matter expert working in concert with internal customers and clients to explain new programs and results.
• Lead Analytics and Quality teams in vetting new programs for actualized scenario concepts.
  

Position Requirements:

• 5+ years of experience in value-based reimbursement, through managed care contracting, provider reimbursement, consulting, population health delivery or related areas.
• 7+ years experience in data analytics, predictive modeling, and working with large datasets from payers, providers, and employers.
• Prior experience with Medicare risk model.
• In-depth knowledge of various reimbursement structures and payment methodologies for both hospitals and providers.
• Knowledge and experience with value-based contracting and accountable care models: episodes, bundles, PCMH, gainshare, risk.
• In-depth knowledge of managed care business, including regulatory/legal requirements.
• Bachelor’s degree in business, information management, or related field.
• Comprehensive knowledge of healthcare data primarily in eligibility, provider, claims and claims payment.
• Skilled at:
• queries, database programming languages (e.g. SQL, Python, R, or SAS);
• report design and creation;
• workflows, process development and management; and
• presentation, collaboration, and knowledge-sharing.
• Ability to effectively diagnose potential barriers and propose resolutions that have measurable and positive business impact.
• Experience in presenting complex information in a clear, understandable and visual manner.
• Proficient in MS Word, PowerPoint, and advanced Excel.
• Experience supervising one or more junior team members.
• Comfortable in a multiple client-serving team in a high-pressure, deadline-driven environment.
• Demonstrated leadership skills and desire to take on more than assigned in an entrepreneurial environment. 
• High attention to detail and organizational skills.
• Positive and driven problem solver.
• Excellent strategic thinking, decision making, and problem solving skills.
• Excellent written and verbal communication, professional writing, and presentation skills.
• Ability to travel periodically.

Preferred:

• Prior experience in healthcare analytics and/or data science space or healthcare claim adjudication systems.
• Prior experience in alternative payment models, specifically bundled payments.
• Experience with visualization tools such as Tableau, MicroStrategy, Power BI, Qlikview, or similar.
• Experience with cloud based platforms, Amazon S3, and relational databases such as Redshift.

Position Perks:

Enlace Health offers competitive benefits and perks to all our employees! Our comprehensive benefits package is one of the many ways we show our employees how valued they are. All full-time employees are eligible for the following:

• FREE medical, dental, and vision insurance for employees on select plans
• $600 annual contribution into qualifying HSAs
• UNLIMITED time off
• Matching 401(k) plan
• Mac laptop and accessories
• Company-paid short-term and long-term disability
• Company-paid life insurance
• Annual professional development stipend

All employees are required to maintain confidentiality as related to patient information. Employees are required to follow the acceptable use policy while using any information systems owned or controlled by Enlace. Any disclosures of confidential information made unlawfully outside the proper course of duty will be treated as a serious disciplinary offense. Security roles and responsibilities include:

• Implementing and acting in accordance with the organization’s information security policies
• Protecting assets from unauthorized access, disclosure, modification, destruction, or interference
• Executing particular security processes or activities
• Ensuring responsibility is assigned to the individual for actions taken
• Reporting security events or potential events or other security risks to the organization

The above statements are intended to describe the general nature and level of work being performed by people assigned to this position. The requirements listed above are representative of the minimum knowledge, skill, and/or ability required. To perform this job successfully, an individual must be able to satisfactorily perform the essential functions of the job according to specific company requirements. Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions. Qualified applicants will be afforded equal employment opportunities without discrimination because of race, creed, color, national origin, sex, disability, or marital status.