Healthcare Data Economist

Welcome to Pathways Health Partners, the Accountable Care Organization (ACO) that's leading the charge in helping independent providers transition to Value-Based Care.

What We Do: Medicare REACH ACO: We're at the forefront of Medicare innovation.

Medicare Advantage MSO: Providing top-notch services to our Medicare Advantage patients.

Commercial MSO: Managing care for approximately 16,000 patients across North-West/Central Florida.

Where We Operate: From The Villages to St.

Petersburg, and across to Mount Dora, we've got you covered! Our Services: Hospital Medicine Group: Delivering exceptional care in hospitals.

Affiliated Medical Practices: Managing several top-tier medical practices.

Insurance Agency: Offering comprehensive insurance solutions.

Join us on our journey to better health and value-based care! Job Summary: The Health Care Economist shows leadership where Pathways money and outcomes are actually going.

Using Pathways CMS Claim and Claim Line Feed (CCLF) files and related CMS reports, the position projects how the ACO makes or loses money at every level: across the whole ACO, by participant and provider, and down to the individual patient and each episode of care.

The position analyzes claims, cost, and utilization data; builds and maintains the financial models behind our value-based care arrangements (ACO REACH, LEAD, and Medicare Advantage); and turns that analysis into decisions leadership can act on from how we structure contracts to which care interventions are worth scaling.

This is a working leader role: the Health Care Economist owns the decisions that come from their work, not a report that sits on a shelf.

Role and Responsibilities Position Competencies: 1.

Applies statistical and econometric methods to imperfect, real-world data and draws defensible conclusions from it.

2.

Understands CMS claims data structures (CCLF), including claim adjustments, cancellations, and run-out, and can reconcile internal results to CMS reports.

3.

Understands Medicare payment models, CMS ACO benchmark and shared savings/loss methodology, and CMS-HCC risk adjustment.

4.

Explains technical findings in plain English to non-technical audiences, in writing and in person.

5.

Knows and maintains professional communication skills: verbal, written, and non-verbal communication.

6.

Understands and maintains the highest level of HIPAA (Health Insurance Portability and Accountability Act) standards.

Qualifications/Position Requirements: 1.

Education: Masters degree or Ph.D.

in health economics, economics, health policy, public health, statistics, or a related quantitative field.

2.

Experience: Minimum of 3 years analyzing health care cost and utilization data in a payer, provider, ACO, or consulting setting, including hands-on work with CMS CCLF files or comparable Medicare fee-for-service claims data.

3.

Certification/Licensure: None required.

4.

Training and Knowledge Required at Time of Hire: Statistical and econometric methods (regression, risk ad...