AVP, Medicare Quality Analytics

OverviewAlignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. This fast-growing company offers room for growth and innovation, with work that matters—improving lives and saving them.The Associate Vice President (AVP), Data Science & Analytics – Medicare Quality, is a senior leadership role responsible for the strategy and execution of advanced analytics that drive quality performance for the Star Ratings Program. This role is ideal for a senior-level data scientist with deep experience in healthcare quality measurement, predictive modeling, and data-driven strategy. The AVP will architect the organization’s Star Ratings analytics ecosystem, develop predictive models, generate actionable insights, and shape data strategies that influence quality outcomes. The role blends hands-on data science with strategic vision and acts as both a technical authority and a key business advisor.The AVP will collaborate with clinical, business, and operational leaders to translate data science findings into effective interventions. This includes owning forecasting models, leading exploratory analysis to uncover performance levers, and mentoring a team of analytics professionals to ensure technical and strategic excellence.Essential duties and responsibilities focus on data modeling, actionable insight generation, forecasting and performance monitoring, subject matter expertise and compliance, executive and cross-functional partnership, and team leadership and development.ResponsibilitiesLead the design, development, and refinement of advanced statistical and machine learning models to predict and optimize Star Ratings performance.Own the analytics platform roadmap to support current and future needs.Translate model outputs into actionable insights for members, providers, and measures; embed insights into clinical outreach, population health, and member engagement workflows.Develop forecasting models for the Star Ratings Program, including risk-adjusted simulations; create and maintain performance dashboards.Serve as the organization’s subject matter expert on Star measures (e.g., HEDIS, CAHPS, HOS, Part D) and support regulatory reporting and CMS audit readiness through data validation.Partner with clinical, quality, and business leaders to interpret data and inform decisions; present findings to executives with clear business value.Lead and mentor a team of data scientists and analysts; promote best practices in modeling, coding, data wrangling, and visualization.QualificationsRequired: Bachelor’s degree in Health Informatics, Computer Science, Data Science, Business Analytics or related quantitative field.Required: Minimum 10+ years in data science, data engineering, or related field with experience designing and delivering large-scale data solutions; significant leadership experience; healthcare industry knowledge, especially Medicare Advantage and the CMS Star Ratings System.Required: Expert-level proficiency with modern data architectures (cloud platforms such as Azure, data warehousing, data lakes, ETL/ELT); data governance and data quality experience; healthcare data security and compliance understanding.Preferred: 10+ years in Medicare Advantage Plans; 10+ years in a technical leadership role in healthcare.EducationRequired: Bachelor’s degree in one of the above fields.Preferred: Master’s degree in a related field.Specialized SkillsTechnical & Domain Expertise in Medicare Advantage, CMS Star Ratings, HEDIS, CAHPS/HOS, and pharmacy data (PDE).Advanced modeling and statistical strategy; model selection, validation, and interpretation for strategic decisions.Analytical data architecture and engineering; data preparation, feature engineering, and data integrity for modeling and reporting.Technical leadership with proficiency in Python and advanced SQL; establish coding and reproducibility best practices.Executive translation: distill complex data concepts for non-technical executives; articulate business value and strategic implications.Strategic thinking and roadmap development; anticipate CMS regulatory changes and scale with growth.Stakeholder management and influence; build consensus across clinical, business, IT, and compliance teams.Mentorship and thought leadership; elevate the organization’s data capabilities.Problem-solving: design practical, sustainable technical solutions for complex problems.Requirements & ComplianceEssential physical functions and reasonable accommodations are provided per policy; standard notices pensation & NoticesPay Range: $149,882.00 - $224,823.00. Pay may vary by location, education, responsibilities, and experience.Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.Disclaimer: Please be aware of recruitment phishing scams. Alignment Health will never ask for payment as part of consideration for employment. If you suspect a scam, report to the Federal Trade Commission or verify legitimacy with . #J-18808-Ljbffr

Created: 2025-09-17