Medical Economist

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. The Medical Economist plays a critical role in improving clinical outcomes, quality performance, and cost efficiency for the Medicare Advantage population. This role applies health economics and advanced analytics to evaluate utilization patterns, quality gaps, and return on investment (ROI) of clinical and care management interventions. The Medical Economist identifies high-impact opportunities to improve member outcomes while reducing avoidable medical spend and supports data-driven decision-making across clinical and operational teams. Job Responsibilities: Clinical Outcomes & Quality • Analyze the relationship between clinical interventions, utilization patterns, and member outcomes across the Medicare Advantage population • Evaluate performance on CMS quality measures (e.g., Stars, HEDIS, CAHPS) and identify drivers of quality gaps and improvement opportunities • Assess variation in clinical practice patterns and outcomes across providers, settings, and member subpopulations • Partner with Clinical and Quality teams to prioritize interventions that improve outcomes, equity, and quality performance Utilization & Cost Management • Conduct detailed analyses of medical utilization (e.g., inpatient admissions, ED use, post-acute care, pharmacy, and high-cost services) • Identify inappropriate, avoidable, or low-value utilization and quantify associated cost and quality impacts • Support utilization management and care management strategies through economic and outcomes analysis • Monitor trends in service use and evaluate the impact of clinical programs on utilization shifts across settings of care ROI & Economic Evaluation • Design and execute ROI analyses for care management programs, supplemental benefits, and clinical initiatives • Develop economic models to estimate cost savings, quality improvement, and long-term value of interventions • Perform cost-effectiveness and budget impact analyses to inform investment and prioritization decisions • Track realized vs. expected performance of initiatives and refine assumptions based on real-world results Opportunity Identification & Strategy • Proactively identify high-impact opportunities to improve outcomes and reduce total cost of care using claims, clinical, and quality data • Segment populations to identify high-risk, rising-risk, and high-opportunity cohorts for targeted intervention • Support value-based care and provider performance strategies by identifying opportunities to improve quality and efficiency • Translate analytical findings into clear, actionable recommendations for clinical, operational, and executive leadership Cross-Functional Collaboration & Communication • Work closely with Clinical, Actuarial, Finance, Network, and Quality teams to align economic insights with operational execution • Present findings and recommendations to senior leaders, including Medical Directors and executives • Support regulatory and internal reporting by providing clear documentation of methods, assumptions, and results Job Requirements: Experience: Required: • 3-7+ years of experience in medical economics, healthcare analytics, or outcomes research, preferably within Medicare Advantage • Strong understanding of Medicare Advantage payment, quality programs, and clinical economics • Demonstrated experience analyzing healthcare utilization, quality outcomes, and ROI • Proficiency in SAS, R, Python, SQL, and/or similar analytical tools • Experience working with large claims, encounter, and clinical datasets Education / Training: Required: • Master's degree or PhD in Health Economics, Public Health, Health Services Research, Economics, Biostatistics, or a related field Preferred: • Lean Six Sigma, other processes improvement certification, Certified Professional in Healthcare Quality (CPHQ), or Certified Professional in Healthcare Management (CPHM) Specialized Skills: Required: • Experience evaluating care management, population health, or value-based care programs • Familiarity with CMS Stars measures, risk adjustment, and supplemental benefits • Experience partnering directly with clinicians or medical leadership • Knowledge of health equity analysis and outcomes stratification Essential Physical Functions: The physical demands described here are representative of those that must be met by an employee to successfully per