高级顾问-模型支付设计
Senior Advisor - Model Payment Design
Overview
Position Title: 高级顾问 – 支付设计项目 Supported: SPHG 模型支付设计工作：每周20小时 工作地点：远程 薪资：每小时89 - 95美元
Summary ORAU 寻求一位在医疗支付设计和基于价值的护理方面具有深厚专业知识的资深顾问，以支持医疗保险和医疗补助服务中心（CMS）创新中心（CMMI）。
该高级顾问将就《社会保障法》第1115A(a)(3)节授权的创新支付模型的研究、开发和优化提供建议。此职位将在多个模型中提供高水平的专业知识。高级顾问将就模型设计、文档、审批材料以及适用的数据分析提供建议，以支持医疗补助和医疗保险背景下的决策。
Primary Purpose 作为支付模型设计方面的专家，拥有在医疗补助、医疗保险、儿童和成人人群中的丰富经验。高级顾问将为多个模型团队提供建议，支持支付政策制定，参与文档和审批工作，并在需要时提供分析见解。
Responsibilities
Key Duties and Responsibilities（约每周20小时，远程工作）
- 支付模型设计与支持 – 就替代支付模型（APM）特征的设计提供建议，包括上行/下行风险、整体预算、按人头付费、共享节约/损失、风险走廊和其他支付方法。
- 模型文档与审批 – 审阅并提供对模型设计文档、审批包、概念论文和面向公众的材料的见解，确保准确性和与政策意图的一致性。
- 跨模型咨询支持 – 为多个模型团队提供专业知识；参与工作组会议，就政策选项开发提供建议，并确保各项目之间的协调一致。
- 政策制定与利益相关者参与支持 – 协助模型团队准备内部和外部参与，包括利益相关者咨询、访谈、RFI（请求信息）和政策讨论。
- 数据分析与建模 – 支持或审核定量建模和财务模拟、基准分析，以及根据需要评估支付设计参数。
- Qualifications
- 支付设计专业知识• 具备设计APM的经验，包括整体预算、按人头付费、共享节约/损失、风险走廊和财务风险安排。• 对总成本归因方法有深入理解
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Overview
Position Title: Senior Advisor – Payment Design Project Supported: SPHG Model Payment Design Effort: 20 hours/weekWork Location: Remote Salary: $89 - $95 per hour
SummaryORAU seeks an experienced Senior Advisor with deep expertise in healthcare payment design and value‑based care to support the Centers for Medicare & Medicaid Services (CMS) Innovation Center (CMMI).
The Senior Advisor will advise on the research, development, and refinement of innovative payment models authorized under Section 1115A(a)(3) of the Social Security Act. This role provides high‑level subject matter expertise across multiple models. The Senior Advisor will advise on model design, documentation, clearance materials, and when applicable data analysis to inform decisions across Medicaid and Medicare contexts.
Primary PurposeTo serve as a subject matter expert in payment model design, bringing extensive experience across Medicaid, Medicare, pediatric, and adult populations. The Senior Advisor will advise multiple model teams, support payment policy development, contribute to documentation and clearance, and offer analytical insight when needed.
Responsibilities
Key Duties and Responsibilities(Approx. 20 hours/week, remote work)
- Payment Model Design & Support – Advise on the design of alternative payment model (APM) features, including upside/downside risk, global budgets, capitation, shared savings/losses, risk corridors, and other payment methodologies.
- Model Documentation & Clearance – Review and offer insights on model design documents, clearance packages, concept papers, and public‑facing materials ensuring accuracy and alignment with policy intent.
- Cross‑Model Advisory Support – Provide expertise across multiple model teams; participate in working sessions, advise on policy option development, and ensure alignment across programs.
- Support for Policy Development & Stakeholder Engagement – Assist model teams in preparing for internal and external engagement, including stakeholder consultations, interviews, RFIs, and policy discussions.
- Data Analysis & Modeling – Support or review quantitative modeling and financial simulations, benchmarking analyses, and evaluation of payment design parameters as needed.
Qualifications
Payment Design Expertise• Experience designing APMs, including global budgets, capitation, shared savings/losses, risk corridors, and financial risk arrangements.• Strong understanding of attribution methodologies for both total cost of care and episode‑based models.• Working knowledge of benchmark development approaches and risk adjustment methods (clinical, demographic, social risk).
Medicaid & Medicare Knowledge• Direct experience with Medicaid managed care rate development, capitation pricing, and HCBS payment methodologies.• Understanding of Medicare payment systems, CMS innovation model structures, and related rate-setting principles.
Pediatric & Adult Population Expertise• Background in pediatric payment models and Medicaid‑funded pediatric services.• Experience with adult populations across both Medicaid and Medicare.
Documentation & Policy Development
• Experience developing model memos, policy documents, clearance materials, and public‑facing technical materials.
Analytical Skills (Preferred)• Experience conducting financial simulations, benchmarking analyses, data evaluation, and quantitative modeling.
Education & Experience Requirements• Master’s degree in public health, health economics, or closely related field. • 10+ years of relevant experience in healthcare payment model design, value‑based care, and Medicaid/Medicare programs.
Originally posted on Himalayas