Lumeris

Data Scientist

• Design, build, and maintain primary analytic assets, dashboards, and reporting for Part C and Part D risk-score performance
• Develop and maintain risk-score and revenue forecasting models, compare projections to actuals, and decompose variances into documented drivers
• Trace diagnoses and HCCs from source to payment using submission and response data such as EDPS and MAO-004
• Create repeatable reconciliation controls across the diagnosis-to-payment lifecycle
• Analyze and track recapture and chart-review recovery opportunities using documented valuation rules
• Partner with internal teams to prioritize opportunities and measure performance by provider, program, vendor, and intervention
• Automate recurring reporting through scalable dashboards, reusable SQL, documented business logic, and repeatable processes
• Own business logic, metric definitions, and data-quality criteria for accurate, reproducible reporting
• Translate complex model, coding, and financial logic into decision-ready narratives for leadership and non-technical stakeholders
• Monitor Medicare Advantage Risk Adjustment regulatory changes and quantify their impact on data, forecasts, and operations
• Serve as analytic truth owner and senior builder/strategic partner to Risk Adjustment, Finance, Actuarial, and other departments
• Report directly to the Senior Director of Health Plan Analytics and partner with the VP of Risk Adjustment Solutions and Strategy

Principal Risk Adjustment, Revenue Integrity Analytics Lead

Strategy

• Build and operationalize a standardized enterprise-wide framework for mapping, testing, deploying, and tracking member journeys
• Define and enforce journey campaign structures, channel hierarchies, and communication standards
• Audit journeys and touchpoints to identify drop-off points, operational bottlenecks, and messaging friction
• Optimize the senior member journey for Medicare Advantage populations, including digital literacy, age-in transitions, and accessibility needs
• Manage journeys from strategic design through live operational pathways, with continuous monitoring and refinement
• Partner with Quality, Clinical, Care Management, Network, and Provider Engagement leaders to identify pain points and priorities
• Own the end-to-end design, building, integration, and delivery of prioritized journeys
• Coordinate siloed business units to ensure seamless member transitions, digital tracking, and operational handoffs
• Orchestrate cross-functional workstreams without direct reporting authority
• Lead feature prioritization and operational rollout for the member portal and mobile app
• Write business requirements and translate member feedback and user behavior into UX user stories and digital tagging requirements
• Design strategies to accelerate digital registration, benefit navigation, and self-resolution of member inquiries
• Partner with Enterprise Data on the Member 360 initiative and define business and experience requirements
• Build and manage feedback mechanisms including digital intercept surveys, NPS, focus groups, and complaint analytics
• Translate member behavior and operational data into executive insights and dashboards
• Link member experience enhancements to CAHPS, HEDIS, and HOS outcomes while ensuring CMS regulatory compliance
• Build service recovery protocols and conduct root-cause analyses
• Align experience strategies with provider relations and network operations

CX Strategy Director

Account Manager

• Identify, research, and prioritize high-value provider organizations and health systems in target markets
• Design and execute outreach strategies to secure access and build trust with C-suite and executive leaders
• Serve as Essence Healthcare’s primary brand ambassador and external representative in new markets
• Articulate the plan’s unique value proposition and clinical models
• Cultivate relationships within regional healthcare ecosystems to position Essence Healthcare as a preferred Medicare Advantage partner
• Conduct market analyses covering competitive dynamics, provider readiness, strategic fit, and financial viability
• Translate market data, provider insights, and product capabilities into strategic partnership plans
• Collaborate with Network, Product, Finance, Actuarial, Legal, Marketing, Contracting, and Operations teams on partnership structures and execution
• Develop and present business cases and strategic value propositions to provider C-suite leadership teams
• Facilitate strategic discussions between Essence Healthcare and prospective partner organizations
• Own end-to-end relationship management from initial engagement through opportunity development, internal coordination, and transition
• Maintain an organized pipeline and provide milestone reports to the SVP, Growth and executive stakeholders
• Coordinate cross-functional teams around partnership priorities and selective market-entry decisions
• Facilitate executive sponsorship and strategic conversations to advance high-value partnerships
• Gather market intelligence and competitor trends to refine partnership strategy and product positioning
• Maintain strategic oversight and relationship continuity through diligence, contracting, and final execution

Strategic Partnerships Director

Field Engineer

• Lead discovery sessions with clinical, technical, and operational executives and leaders
• Uncover current-state workflows, pain points, data infrastructure constraints, and strategic priorities
• Map client requirements to viable Tom use cases
• Identify solution risks, feasibility issues, and implementation dependencies
• Deliver custom demonstrations illustrating future-state care delivery enabled by Tom
• Facilitate Tom Immersion Studio experiences
• Explain AI models, RAG, data ingestion, and related technical mechanics in terms of business and clinical value
• Co-create deal-specific Points of View and customized solution blueprints
• Define use cases, integration/configuration assumptions, pilot parameters, and phased deployment approaches
• Partner with Growth account owners on account-level strategy
• Co-develop client-specific value hypotheses, ROI models, and business-case inputs with Finance and Revenue teams
• Contribute to RFIs, RFPs, and security questionnaires
• Ensure disciplined handoffs from Sales to Implementation and Customer Success
• Document use cases, workflow designs, scoped parameters, success metrics, and clinical/technical assumptions

Field Solutions Engineer

• Lead discovery sessions with clinical, technical, and operational executives and leaders
• Uncover current-state workflows, pain points, data infrastructure constraints, and strategic priorities
• Map client requirements to viable Tom use cases
• Identify solution risks, feasibility issues, and implementation dependencies
• Deliver custom demonstrations illustrating future-state care delivery enabled by Tom
• Facilitate Tom Immersion Studio experiences using clinical storytelling
• Explain AI models, RAG, data ingestion, and business/clinical value
• Co-create deal-specific Points of View and customized solution blueprints
• Define use cases, integration/configuration assumptions, pilot parameters, and phased deployment approaches
• Partner with Growth team account owners on account-level strategy
• Co-develop client-specific value hypotheses, ROI models, and business-case inputs with Finance and Revenue teams
• Contribute to RFIs, RFPs, and security questionnaires (DDQs)
• Ensure disciplined handoff from Sales to Implementation and Customer Success teams
• Document use cases, workflow designs, scoped parameters, success metrics, and clinical/technical assumptions

• Identify, research, and prioritize high-value provider organizations and health systems in target markets
• Design and execute outreach strategies to build trust with C-suite and executive leaders at prospective partner organizations
• Represent Essence Healthcare as a brand ambassador and external representative in new markets
• Articulate Essence Healthcare’s value proposition and clinical models
• Cultivate relationships within regional healthcare ecosystems to position Essence Healthcare as a preferred Medicare Advantage partner
• Conduct market analyses covering competitive dynamics, provider readiness, strategic fit, and financial viability
• Translate market data, provider insights, and product capabilities into strategic partnership plans
• Collaborate with Network, Product, Finance, Actuarial, Legal, Marketing, Contracting, and Operations teams on value-based care, risk-sharing, and joint-venture opportunities
• Develop and present business cases and strategic value propositions to external provider C-suite leadership teams
• Facilitate strategic discussions between Essence Healthcare and prospective partner organizations
• Own end-to-end relationship management from initial engagement through opportunity development, internal coordination, and transition
• Maintain an organized strategic partnership pipeline and provide milestone reports to the SVP, Growth and executive stakeholders
• Coordinate cross-functional teams around partnership priorities and selective market-entry decisions
• Facilitate executive sponsorship, resolve key issues, and advance high-value partnerships
• Gather market intelligence and competitor trends to refine partnership strategy and product positioning
• Maintain strategic oversight and relationship continuity through diligence, contracting, and final execution

Strategic Provider Partnerships Director

Medical Director

• Provide strategic direction and clinical expertise to guide policy, programs, and overall healthcare delivery
• Serve as a clinical operations leader and clinical lead for Essence Healthcare
• Oversee, coach, mentor, motivate, support, and develop a cross-functional team of seasoned people leaders
• Oversee and coordinate clinical aspects of the health plan, including medical and pharmacy management, utilization review, and evidence-based care initiatives
• Manage medical costs
• Plan and facilitate medical director meetings
• Foster relationships with Essence physicians and partner with medical groups on provider performance management
• Align physician incentives, quality measures, and value-based contracts
• Maintain relationships with ARO Value Based Care Enablement CMOs and clinical teams at partnering organizations
• Direct and monitor medical management activities and quality management programs for compliance with CMS, NCQA, and other accrediting bodies
• Collaborate with the Corporate Chief Medical Officer on clinical strategy, design, communications, and risk management
• Act as an internal consultant on clinical program development and special projects for Lumeris customers
• Support the Accountable Delivery Systems Institute on accountable care, physician engagement/alignment, payer and clinical transformation, and technology-enabled care models
• Contribute to clinical thought leadership through presentations, case studies, and scientific articles

Chief Medical Officer

Customer Success Manager

• Own ongoing operations and success of customer accounts post-implementation
• Drive account expansion, product adoption, customer satisfaction, and long-term retention
• Lead key customer accounts as a player-coach
• Document, build, and scale the Customer Success Manager team structure
• Mentor Customer Success Managers and build a high-performing team
• Identify customer expansion opportunities and maximize value from Tom’s AI-powered healthcare solutions
• Lead onboarding, utilization, and satisfaction for the first clients
• Transition from direct account management into leadership of the customer success function
• Collaborate with Product to define success metrics, reporting structures, and data visualizations
• Partner with the VBC Product Manager to align customer success goals with value-based care initiatives
• Drive adoption of Customer Success best practices
• Work with Enablement and Technical Implementation teams on customer activation and product education
• Track, report, and follow up on adoption, value, utilization, and engagement of Tom services
• Monitor customer health and use metrics and feedback to identify risks and growth opportunities
• Ensure the team has the tools, resources, support, knowledge, and training needed to succeed
• Keep customers informed and engaged on new products, updates, and services

Principal Risk Adjustment, Revenue Integrity Analytics Lead

CX Strategy Director

Strategic Partnerships Director

Field Solutions Engineer

Field Solutions Engineer

Strategic Provider Partnerships Director

Chief Medical Officer

Director, Customer Success