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

Actuarial Analyst

Senior Advisory Consultant, Actuary

Executive Director, Actuarial

Actuary – Network Performance & Execution