Staff Healthcare Analyst at Abby Care · LumiJobs

Responsibilities

We are looking for a Staff Healthcare Analyst at Abby Care. The role leads efforts spanning patient risk modeling and clinical outcomes measurement to the cost and value analysis behind the story we bring to health plans, payors, and government partners. The role is expected to be the subject matter expert for clinical and health economics analytics at the company.
Reporting to the Senior Manager of Data & Analytics, you will set the strategy and standards for how we measure risk, cost, and outcomes, and build the analytical models and studies that prove the value of family-led care. You will develop the methodology, evidence, and analysis that our Clinical, Finance, and executive teams rely on in conversations with payors, actuaries, and research partners. You will work hand-in-hand with our Clinical and Health Plan teams, and closely with Finance, Engineering, and Product on the cross-functional initiatives that power this work.
This is a full-time, hybrid role based in San Francisco, California.
Population health & risk
Build patient stratification and risk models (e.g., utilization risk, hospitalization/adverse event risk, acuity tiers) that inform care prioritization and intervention design.
Own risk adjustment methodology (e.g., HCC/RAF-style approaches) and ensure it aligns with payor and regulatory expectations.
Analyze payor claims data (medical and pharmacy) to identify utilization patterns, cost drivers, and gaps in care, and to inform and validate risk models.
Health economics & value-based care
Lead cost of care and ROI analyses (total cost of care, cost offset, medical loss ratio impact) that quantify the value of family-led care for health plans and government partners.
Structure and analyze value-based care and risk-sharing arrangements; model shared savings, care management fees, and other VBC contract structures.
Develop and validate the methodology, assumptions, and results that Finance rely on when negotiating with payors and actuaries and responding to audits.
Clinical outcomes & evidence generation

Staff Healthcare Analyst

Responsibilities

Qualification

Preferred

Benefits

Company

Abby Care

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