Medical Home Network

Actuary

• Lead actuarial modeling and financial forecasting across CMS programs including MSSP, REACH, Medicare Advantage, and Medicaid value-based initiatives, ensuring deep alignment with current regulatory and benchmarking methodologies.
• Oversee the design and evaluation of value-based care payment models, including shared savings/loss arrangements, capitation, prospective budgets, and performance incentive programs.
• Direct enterprise-wide risk adjustment strategy for Medicare Advantage, MSSP/ACO REACH, and Medicaid, optimizing coding accuracy, risk capture processes, and prospective RAF forecasting.
• Work with contracting team to support contract negotiation including new contracts and contract renewal including shared savings, capitation, and total cost of care models.
• Partner with clinical, quality, and coding teams to ensure compliant and effective risk adjustment operations and year-round performance monitoring.
• Develop actuarial analyses supporting network design, provider performance evaluation, incentive structures, and payment model optimization across Medicare Advantage and Medicaid networks.
• Manage actuarial analysis for settlements, reconciliations, and ongoing contract performance.
• Develop and maintain an actuarial/economic framework for evaluating risk in value-based care contracts across contracts
• Identify risks and proactively develop and present mitigation recommendations for clinical and performance teams.
• Partner with data science and population health teams to enhance predictive models for patient risk stratification and care management targeting.
• Interface cross-functionally and perform analyses to fulfill the requirements of other MHN teams
• Communicate complex actuarial findings clearly to non-technical stakeholders, including clinicians, executives and external partners.

Director, Actuarial Services

Medical Director

• Reporting to the Chief Medical Officer, the Associate Medical Director drives MHN’s clinical innovation, care delivery redesign, and value-based performance across markets.
• This role strengthens care design to improve outcomes, reduce total cost of care, and support strategic growth within Medicare, Medicaid, and ACO models.
• Success in this role requires frequent travel to provider sites, fostering collaboration, coaching and guiding clinical teams, influencing workflows, and enhancing the patient and provider experience.

Associate Medical Director

Operations

• The Director, Performance & Operations- Wellness West leads the operational, financial, and stakeholder engagement efforts of Wellness West, ensuring the organization effectively delivers on its mission.
• This role oversees budgeting and financial operations, manages government affairs and board relations, and supports the organization’s communications and social enterprise initiatives.
• The Director will work closely with a diverse range of stakeholders, including health and community partners, government entities, and board members- to ensure strategic alignment, operational excellence, and fiscal responsibility.
• This individual plays a critical role in driving collaboration across partners, advancing evaluation and performance initiatives, and representing Wellness West in external communications and policy discussions.

Director, Performance & Operations – Wellness

Business Intelligence Developer

• Partner with internal teams to understand business needs and translate findings into clear, actionable insights.
• Build interactive dashboards, reports, and presentations that effectively communicate key performance trends and outcomes.
• Assist with the design and implementation of a Snowflake based data platform supporting analysis and reporting needs.
• Analyze data from multiple sources (e.g., claims, EHR, operational data) to support initiatives related to population health and value-based care.
• Provide ongoing support for existing dashboards and reporting products, including troubleshooting and user guidance.
• Collaborate across technology and operations teams to ensure data quality, consistency, and reliability across systems.

Manager

• Engage with patients during hospitalization focusing on reasons for hospitalization, reinforcing care management plan of care, updating information for the Medical Home Care Management team, plan of care post-discharge, and goal setting
• Complete assessments as appropriate, such as risk screenings, initiate Care Plan, TOC Bundle, and others as needed
• Educate and support patients in health literacy, medication management, plan for follow-up and ongoing care, signs and symptoms of worsening conditions, functional or social needs, home and community-based services, advance directives, and other issues as identified
• Interface with hospital care team including nurses, social workers, case managers, hospitalists, and other staff responsible for utilization management and discharge planning
• Assess patient readiness for change and work with care team to ensure patients discharge to proper services and identify/address barriers to assure efficient and complete transitions of care
• Participate in care team meetings and Integrated Care Team collaboration as necessary
• Develop relationships with staff in inpatient hospitals (general acute and behavioral health) and Medical Home Care Management staff; gather and share medical home and discharge planning information between hospital and medical home
• Work with the patient and medical home to secure timely follow-up appointments
• Communicate and document activities and outcomes to the patient’s medical home care manager regularly
• Assist in leading transitions of care trainings for care management staff
• Participate in quality improvement initiatives as identified
• Other duties as assigned

Director, Actuarial Services

Associate Medical Director

Director, Performance & Operations – Wellness

Business Intelligence Developer

Care Manager, Transitions of Care