Director, healthcare economics (medicare)

Job Details:

Job Location: Huntington Beach Office - Huntington Beach, CA

Position Type: Full Time

Salary Range: $140800.00 - $193525.00

This position operates on a hybrid work schedule. This position will require 3 days onsite at the Huntington Beach office.

Are you ready to make a lasting impact and transform the healthcare space?

We are one of Southern California’s fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.

Who Are We?

Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members’ culture and values.

Why Join Us?

We’re on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you’ll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation.

Job Summary

The Director, Healthcare Economics is responsible for leading healthcare economics analytics, Clinical Affordability initiatives, and Population Health analytic support that advance Clever Care Health Plan’s financial performance, quality outcomes, member health outcomes, and value-based care strategy. This role serves as a hybrid of hands-on analytics leader and strategic business partner, translating complex claims, membership, pharmacy, risk adjustment, Stars, network contracting, value-based care, and population health data into clear insights, executive-ready recommendations, and measurable actions.

Functions & Job Responsibilities

• Provide strategic leadership and governance for the Clinical Affordability forum, setting its priorities and decision agenda, aligning cross-functional stakeholders around the highest-impact affordability opportunities.
• Develop and manage healthcare economics analyses related to claims trend, membership analytics, utilization, unit cost, mix, pharmacy spend, risk adjustment financial performance, Stars analytics, network contracting, and value-based care performance.
• Translate complex data into clear business narratives, identifying cost-of-care drivers, emerging risks, margin opportunities, and recommended actions for senior leadership.
• Partner with Population Health, Quality, and Clinical leadership to evaluate program performance, identify high-risk member cohorts, measure care management impact, and recommend opportunities to improve affordability and outcomes.
• Develop reporting packages that summarize member morbidity burden, chronic condition trends, utilization patterns, pharmacy indicators, care management engagement, and outcomes performance for leadership review and program planning.
• Support the Population Health function by developing analytics that identify priority populations, stratify members by risk and opportunity, and inform targeted interventions for chronic condition management, care gaps, utilization reduction, and improved health outcomes.
• Evaluate and ensure the continued effectiveness of culturally sensitive care models and culturally attuned benefits.
• Support Risk Adjustment and Stars/Quality teams with financial analytics, performance tracking, and insight generation.
• Collaborate with Pharmacy, Network, Finance, Operations, Product, IT, and external vendors to integrate data and develop a unified view of medical cost performance and intervention opportunities.
• Develop repeatable reporting frameworks, dashboards, scorecards, and methodologies that improve consistency, accuracy, and timeliness of Healthcare Economics deliverables.
• Provide leadership and direction to team of analysts, including prioritization of work, review of analytical outputs, coaching on business context, and development of executive communication skills.

Qualifications:

Education & Experience: Bachelor’s degree in Healthcare Administration, Finance, Economics, Actuarial Science, Statistics, Data Analytics, Public Health, Business, or related field; master’s degree preferred. 7–10 years of progressive experience in health care analytics, healthcare economics, actuarial support, financial analytics, or managed care analytics. Medicare Advantage or managed care experience strongly preferred.

Physical & Working Environment

Work is performed in an office environment and/or remotely in a hybrid setting. Ability to operate a keyboard, mouse, phone and perform repetitive motion, including keyboarding and note-taking.

Equal Employment Opportunity

Clever Care Health Plan is proud to be an Equal Employment Opportunity and Affirmative Action workplace.