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Canopy Health is a unique health network that requires wearing multiple hats, working from home, in the office and at facilities as needed on patient volume. represents an innovative Alliance of leading independent healthcare providers that is reinventing healthcare throughout the SF Bay Area. Formed in 2015 by UCSF, John Muir Health, Hill Physicians and Meritage Medical Network, Canopy holds a restricted Knox-Keene license and offers Commercial HMO, Medicare Advantage and EPO health plan products through partnerships with United Healthcare and HealthNet.
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In addition, this role leads value-based contracting (VBC) workflows to include evaluation and forecasting of full and partial risk arrangements between NeueHealth affiliated providers and payors from multiple LOBs (Commercial, Medicare Advantage, Medicaid, etc.
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2+ years working with individual/small group ACA rate filings or Medicare Advantage bids is preferred. Working knowledge of the CMMI Direct Contracting or Accountable Care Organization (ACO) program(s.
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Lead quarterly medical expense analysis, IBNR / Reserving (monthly), and forecasting process, with assistance from actuarial analyst staff. 2+ years working with a CMMI ACO Model (of any kind) is strongly preferred.
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4+ years of actuarial experience with 5+ years working within healthcare. Additional cross-functional support role working with Line of Business, Analytics, Finance, Marketing and other areas of the company that may need data summarization, modeling framework or research help.
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We uniquely align the interests of health consumers, providers,and payors to make high-quality healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.
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Working knowledge of industry value-based contracts between payers and providers (risk sharing arrangements) Perform ad-hoc data analysis using Excel, SAS, SQL (Databricks). Proficient in Microsoft Excel (VBA, advanced data visualization, etc.
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Experience with forecasting, modeling, SQL (Databricks experience is a plus) Support the Government Programs & Provider Risk Actuarial Models teams development of actuarial models to be used for medical expense and trend analysis and forecasting, provider risk contract evaluation, and ACO REACH / MSSP performance evaluation.
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The Senior Actuarial Consultant will lead actuarial workflows in support of ACO REACH & MSSP performance evaluation and forecasting. Bachelor's degree required in Math, Statistics, Economics, Actuarial Science, or a related field.
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Lead provider risk contract evaluations and ACO REACH / MSSP performance evaluations, interfacing with internal NeueHealth team and external consulting actuaries. Lead the evaluation of financial implications of provider participation in networks for ACO REACH / MSSP opportunities.
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Document and present summary review memos in support of the quarterly medical expense analysis and forecasting process in preparation for, and as follow up to, collaboration with various owned clinics and NeueHealth SMEs and leaders.
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Understanding of company practices related to management of member populations for purposes of estimating risk. Produce, understand, and interpret internal and external analysis and reports; provide effective technical and non-technical support to internal and external stakeholders.
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Collaborate with Finance team in the development of forecasting models, projections and relevant information to inform C-Level business decisions. Actual compensation will vary based on the applicants education, experience, skills, and abilities, as well as internal equity.
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We are transforming healthcare to be value-driven, creating a seamless, consumer-centric care experience that maximizes value for all. For individuals assigned to a location(s) in New York, NeueHealth is required by law to include a reasonable estimate of the compensation range for this position.
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Lead the development of contract analysis assumptions to inform contract evaluation decisions and plan benefit development and provide guidance to NeueHealth and the owned clinics teams. A reasonable estimate of the range is $116,551.53 - $174,827.30 annually.
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