Value Based Care Cost and Utilization Analyst

Description:

We're Hiring: Value Based Care Cost and Utilization Analyst

[Remote with ability to travel occasionally in State of Colorado]

Join Carina Health Network and help us make Colorado communities healthier!

Are you passionate about population health and interested in improving patient experience and outcomes? We support community health organizations across Colorado with technology, data, and resources that help people get the care they need, when and where they need it. If you're looking for a mission-driven organization where your work has a real impact in real communities, Carina could be the right place for you.

At Carina Health Network, we’re transforming community health by helping our members deliver proactive, data-informed, and whole-person care that drives measurable impact. Our work helps people with chronic conditions like diabetes and high blood pressure stay healthier, ensure older adults get regular check-ups, and identify mental health needs early. We help reduce unnecessary emergency room visits by connecting people with the right care at the right time.

Through our value-based care programs, we empower frontline care teams to improve outcomes while earning fair, sustainable reimbursement. By saving money and reinvesting in health services, we strengthen the systems that care for Colorado’s underserved populations, making a meaningful difference for both care teams and the patients they serve.

Join us in reimagining the future of health care, where your work truly matters.

What You’ll Do

The Cost & Utilization Analyst is responsible for leading the analysis, interpretation, and dissemination of cost and utilization data across Carina Health Network’s partner organizations. The Cost & Utilization Analyst supports efforts to demonstrate the financial performance, efficiency, and impact of value-based care programs within the network. The goal of the position is to inform strategy, identify opportunities to reduce unnecessary costs, improve utilization, enhance shared savings, and maximize the value of care delivered to vulnerable populations served by partners.

Core Analysis & Reporting

• Apply quantitative and qualitative methods to evaluate cost, utilization, population health, and program performance.
• Conduct in-depth analyses of total cost of care (TCOC) by CHC, provider, and patient, identifying high-cost beneficiaries, frequent ED utilizers, and drivers of inappropriate utilization, utilizing claims, EHR, HIE data, and other data feeds.
• Perform leakage and out-of-network spend analyses; assess pharmacy costs, low-value care, and other key cost drivers.
• Prepare monthly expected vs. actual spend reports, including variance and trend analysis and present findings to a variety of audiences.
• Monitor and forecast shared savings performance across contracts, including in-depth analysis for CHCs above expected spend.
• Correlate HCC and RAF scores with cost and performance metrics; identify gaps in diagnosis recapture and coding accuracy.
• Analyze attribution patterns (e.g., MSSP, new patient growth, unengaged attributed patients) and identify opportunities for improved engagement.
• Evaluate the financial impact of performance improvement initiatives and provide actionable recommendations to support strategy and profitability.

Collaboration & Visualization

• Partner with Business Intelligence to design dashboards and scorecards (e.g., ED use, inpatient admissions, readmissions, post-acute utilization, out-of-network spend, pharmacy costs) for both internal and external stakeholder use.
• Translate analytic results into clear narratives and actionable insights for diverse audiences, using plain language when presenting to non-technical stakeholders.
• Collaborate with internal teams, CHC leadership, payors, and technology partners to align analyses with strategic and operational needs.
• Support dissemination of findings through presentations, reports, publications, and conferences.
• Develop subject matter expertise in third party population health solutions to extract, analyze, and interpret cost and utilization data for value-based care initiatives.

Leadership & Organizational Support

• Participate in the planning and design of evaluation frameworks to ensure rigor and alignment with best practices.
• Support business development activities including product evaluations, demonstrations, and presentations.
• Share best practices and facilitate collaboration across Carina partner organizations.
• Attend relevant training, meetings, and conferences to stay current and support professional growth.
• Influence organizational strategy and annual goals by providing insights and recommendations based on data-driven observations

What We’re Looking For

• Bachelor’s degree in Health Economics, Finance, Statistics, Actuarial Science, Public Health, or related field of study
• Master’s preferred
• 3–5+ years of experience in healthcare cost analysis, population health analytics, or value-based care analytics; experience with FQHCs or ACOs highly preferred.
• Strong proficiency in data analytics tools (SQL, Tableau, Power BI, Excel, R/Python).
• Deep understanding of TCOC, shared savings programs, HCC/RAF scoring, HEDIS/quality metrics, MSSP attribution, and population health management.
• Ability to interpret complex datasets and translate findings into actionable recommendations.
• Excellent communication and collaboration skills across clinical, operational, and financial teams.
• Strong organizational skills with the ability to manage multiple projects and meet deadlines.
• Flexible, independent, and self-motivated with high accountability.
• Ability to work remotely with periodic travel as needed.

Why You’ll Love Working Here

• Insured group health, dental, and vison plans (Employer covers 100% of the cost for dental and vision)
• Medical and dependent care flexible spending account options
• Employer contributions $900 annually towards a Health Reimbursement Employer (HRA) or Health Savings Account (HSA), depending on the health plan selected
• 401k retirement plan with up to a 4% employer contribution match
• 100% employer-paid life, AD&D, short-term, and long-term disability plans paid for employees
• Free 24/7 access to confidential resources through an employee assistance program (EAP)
• Voluntary benefit plans to complement health care coverage, including accident insurance, critical illness, and hospital indemnity coverage
• 17 days of paid vacation within one year of service
• 12 paid sick days accrued by one year of service
• 14 paid holidays (which includes two floating holidays)
• One paid volunteer day
• Employer-paid programs/courses for professional growth and development
• Cell phone and internet reimbursement
• Competitive salary and full benefits
• Annual, all expenses paid staff retreat
• Flexible work (remote or hybrid)
• Supportive, mission-driven team
• Opportunities to learn and grow

This job will be posted until filled or until November 30th, 2025.

EEO Statement

Carina Health Network provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Requirements: