AVP, Medicare Quality Analytics

Role Overview

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. The successful candidate will blend hands‑on data science expertise with strategic vision, acting as both a technical authority and business advisor to translate data science findings into effective business interventions.

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.
• 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.
• Forecasting & Performance Monitoring: Own the end‑to‑end development of forecasting models for the Star Ratings Program, including risk‑adjusted simulations, and maintain performance monitoring tools and dashboards.
• Subject Matter Expertise & Compliance: Serve as the senior data science subject matter expert on all Star measures (e.g., HEDIS, CAHPS, HOS, PartD). Translate CMS methodology into technical requirements and support regulatory reporting and audit readiness.
• Executive & Cross‑Functional Partnership: Serve as the primary analytics partner to clinical, quality, and business leaders; present complex findings to executive audiences and communicate the connection to business objectives.
• Team Leadership & Development: Lead and mentor a dedicated team of data scientists and analysts, promoting best practices in modeling, coding, data wrangling, and visualization.
• Other duties as assigned.

Job Requirements

• Experience:
  • Required – Minimum 10+ years in data science, data engineering, or related field with a proven track record of large‑scale, complex data solutions.
  • Experience leading technical vision and managing teams.
  • In‑depth knowledge of Medicare Advantage and the CMS Star Ratings System.
  • Expert proficiency with Azure, data warehousing, data lakes, and ETL/ELT processes.
  • Data governance, quality, security, and compliance experience.
  • Preferred – 10+ years in Medicare Advantage plans and in a technical leadership role 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:
  • Domain knowledge of Medicare Advantage, CMS Star Ratings, HEDIS, CAHPS/HOS, and pharmacy data (PDE).
  • Advanced statistical and machine learning modeling, model validation, and interpretation.
  • Data architecture and engineering, advanced feature engineering, data integrity.
  • Technical leadership with Python, advanced SQL; enforce coding best practices.
  • Communication skills – distill complex concepts to non‑technical executives.
  • Strategic thinking, stakeholder management, mentorship, problem‑solving.

Essential Physical Functions

• Talk or hear regularly; stand, walk, sit, use hands and fingers, handle tools, reach with hands and arms.
• Lift or move up to 10 pounds frequently.
• Close vision and ability to adjust focus.

Pay Range

$149,882.00 – $224,823.00 (may vary by location, education, responsibilities, experience).

Equal Opportunity Employer

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.