Job Duties/Responsibilities:

Data Modeling & Strategy: 

Lead the design, development, and continuous refinement of advanced statistical and machine learning models to predict and optimize performance on the Star Ratings Program. 

Own the technical roadmap for the analytics platform, ensuring it supports current and future analytical needs.

Actionable Insight Generation:

Translate model outputs and complex datasets into actionable member, provider, and measure-level insights. 

Partner with cross-functional teams to embed these insights into clinical outreach, population health, and member engagement workflows to guide targeted interventions.

Forecasting & Performance Monitoring: 

Own the end-to-end development of forecasting models for the Star Ratings Program, including the design of risk-adjusted simulations. 

Develop and maintain performance monitoring tools and dashboards to track and measure performance at all organizational levels.

Subject Matter Expertise & Compliance: 

Serve as the organization's senior data science subject matter expert on all Star measures (e.g., HEDIS, CAHPS, HOS, Part D). 

Translate complex CMS methodology into technical data requirements and support regulatory reporting and CMS audit readiness through rigorous data validation.

Executive & Cross-Functional Partnership: 

Serve as the primary analytics partner to clinical, quality, and business leaders, helping them interpret data and make informed decisions. 

Present complex data science findings and model outcomes to executive audiences, clearly communicating the connection to business objectives and strategic value.

Team Leadership & Development: 

Lead and mentor a dedicated team of data scientists and analysts. 

Promote best practices in statistical modeling, coding, data wrangling, and visualization to foster a culture of technical excellence and data-driven inquiry.

Other Duties as Assigned

Job Requirements:

Experience:

• Required: 

• Minimum10+ years data science, data engineering, or a related field, with a proven track record of designing and executing large-scale, complex data solutions.

• Significant experience in a leadership capacity, with demonstrated ability to set technical vision and manage teams. 

• In-depth knowledge of the healthcare industry, specifically Medicare Advantage and the CMS Star Ratings System. 

• Expert-level proficiency with modern data architecture principles, including cloud platforms (Azure), data warehousing, data lakes, and ETL/ELT processes. 

• Demonstrated experience establishing and managing data governance and data quality programs. 

• Strong understanding of data security and compliance requirements in a healthcare context. 

• Preferred: 

• 10+ years’ experience in Medicare Advantage Plans

• 10+ years’ experience in a technical leadership position in a healthcare environment

Education:

• Required: Bachelor’s degree in Health Informatics, Computer Science, Data Science, Business Analytics or related quantitative field.  

• Preferred: Master’s degree in one of the above fields

Specialized Skills: 

Required:  

• Technical & Domain Expertise 

• Healthcare & Stars Domain Knowledge: Required understanding of Medicare Advantage, the CMS Star Ratings Program, HEDIS measures, CAHPS/HOS surveys, and pharmacy data (PDE).  

• Advanced Modeling & Statistical Strategy: The ability to direct and apply sophisticated statistical and machine learning methods to solve critical business problems. This includes overseeing model selection, validation, and interpreting results to guide high-level strategic decisions.  

• Analytical Data Architecture & Engineering: Oversight of the data preparation process, including the strategic design of datasets, advanced feature engineering, and ensuring the integrity of the data used for all modeling and reporting. 

• Technical Leadership & Implementation: Expert-level proficiency in Python and advanced SQL, with the ability to set and enforce best practices for coding, analytical rigor, and reproducibility across the team and its projects.  

• Leadership & Communication 

• Executive Translation: The ability to distill highly complex data concepts, challenges, and technical jargon into clear, concise summaries. Must be able to articulate the business value and strategic implications of ‘technical’ decisions to non-technical executives and stakeholders.  

• Strategic Thinking: Capacity to develop a long-term vision and roadmap that aligns with business objectives, anticipates future CMS regulatory changes, and scales with organizational growth. 

• Stakeholder Management & Influence: Proven ability to build consensus and foster strong relationships with a diverse range of stakeholders, including clinical leaders, business executives, IT teams, and compliance officers. 

• Thought Leadership & Mentorship: The ability to lead through influence, mentor technical staff, and champion best practices to elevate the data capabilities of the entire organization. 

• Problem-Solving: A pragmatic approach to deconstructing complex business and operational problems and designing effective, sustainable technical solutions.  

Essential Physical Functions: 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

1.  While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms. 

2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.