Accountable Care Economics Business Analytics Senior Advisor-Evernorth - Hybrid

Position Overview:

The Medical Economics team's mission is to develop innovative fee-for-service and value-based care network solutions that deliver improved outcomes for patients, providers, and payer clients.

This senior contributor role will collaborate with other industry professionals and lead service area research, offer guidance on setting actuarially-sound targeting criteria, model fee schedule scenario outcomes, and serve as a key contributor to market-facing presentations.

Responsibilities:


* Oversee evaluation of current and prospective network providers as part of Evernorth's national fee-for-service, fully-delegated network development and provider contracting efforts.


* Lead exploratory analytics and financial modeling to identify network structuring opportunities that drive differentiation across market competitiveness and adequacy measures.


* Effectively partner with actuarial, finance, provider contracting, and market teams to ensure all network modeling inputs yield credible utilization and reimbursement outcomes.


* Support rate reviews of third-party contractor proposals and counter offers by assessing the economic impact of each individual provider engagement on overall network performance.


* Conduct fast-paced, test-and-learn market studies to inform network contracting decisions by the Medical Provider Solutions leadership team related to rates, market dynamics, contract structure, and other network evaluation indicators.


* Utilize and enhance existing network modeling tools to develop and continuously optimize rate models based on various contracting structures.


* Executing market-by-market scenario testing and evolve network design best practices.


* Develop leadership in network measurement methods and the integration of new network data sources to deepen understanding of utilization patterns, market trends, and access-to-care considerations.

Qualifications:

This position requires strong healthcare specific data and analytics skills, healthcare and insurance content knowledge, communication skills, technical skills across platforms, and project management.


* At least 6-8 years of hands-on experience in healthcare specific analytics, financial modeling, and/or actuarial/underwriting.


* Experience developing and deploying provider networks that cover key contracting stages including rate setting, provider contracting, resolving contract-related matters, and amending contracts.


* Demonstrate a thorough understanding of medical economics and network contracting concepts.


* Strong technical proficiency in analytic tools and platforms such as MS Excel, Databricks, SQL, PowerBI, and Tableau.


* Effective oral and written communication interfacing with a wide range of network stakeholders.


* Excellent organizational skills and ability to prioritize project workload and day-to-day time commitments.


* Ability to navigate and contribute within a highly-m...