Job Description

ABOUT THE ROLE

As Daymark's first VP of Medical Economics, you'll be the first dedicated medical economics hire, sitting on the senior leadership team. You'll own the full cost-of-care analytics function, building everything from payer-facing savings dashboards to internal utilization reporting on top of Daymark's Tuva data infrastructure.

Core responsibilities span four areas: contract performance analytics (including shared savings calculations, baseline construction, and serving as Daymark's primary analytical counterpart to health plan actuarial teams), savings initiative modeling (across drug episode groupers, clinical pathway adherence, biosimilar conversion, weight-based dosing, and site-of-care shifts), payer growth support (including opportunity assessments, contract term design, and defending methodology in negotiations), and AI and advanced analytics (leading the medical economics AI strategy and building agentic workflows for claims analytics and EHR monitoring).

The role starts as a hands-on individual contributor with a mandate to build out the team over time, ideal for someone who can operate at the analytical and strategic level simultaneously.

Medical Economics & Contract Performance

• Own total cost-of-care analytics across all payer contracts, including PMPM, utilization, and service grouper categories on top of Tuva infrastructure.
• Develop shared savings calculations, baseline and trend construction, and member mix and service mix adjustment approaches that normalize costs across cancer types and acuity cohorts, ensuring adjustments are transparent, reproducible, and defensible to plan counterparts.
• Lead reporting with payer partners and serve as Daymark's primary analytical counterpart to plan medical economics and actuarial teams.

Leading key savings Initiatives, including

• Drug-specific groupers: Design and maintain claims-based drug episode groupers attributing spend by cancer type, line of therapy, and regimen to enable consistent cross-provider and cross-payer comparisons.
• Clinical pathway analytics: Build the analytical foundation for Daymark's clinical pathway guidelines, defining evidence-based, cost-efficient regimen standards by cancer type, line of therapy, and patient cohort; develop provider-level adherence benchmarks that identify outlier prescribing patterns and inform pathway refinement.
• Biosimilar opportunity identification: Build utilization analytics to identify biosimilar conversion opportunities across the oncology drug portfolio; quantify per-episode and savings potential and track adoption against benchmarks.
• Weight-based dosing compliance: Develop claims-based proxies and, where EHR data is available, patient-level BSA-to-HCPCS unit reconciliation to flag overdosing and reduce within-type unit costs.
• Site-of-care analytics: Model the financial impact of site-of-care shifts (hospital outpatient to physician office; office to home infusion) and track migration.

Reporting Infrastructure

• Build and own Daymark's internal and external reporting stack, from payer-facing savings dashboards to internal trend and utilization reports.
• Collaborate with Product and Engineering on data model and agentic workflow development to support medical economics and reporting infrastructure.

AI & Advanced Analytics

• Lead Daymark's medical economics AI strategy, identifying high-value use cases for LLM and agentic workflows in claims analytics and reporting automation.
• Build AI tooling infrastructure and develop agentic EHR monitoring workflows to support proactive care pathway identification.

Payer Growth Contracting Support

• Support claims-based opportunity assessments for new payer partnerships, including cost and utilization benchmarking and savings lever identification
• Support contract term design, including performance guarantee structure, baseline methodology, and savings-sharing mechanics
• Serve as Daymark's analytical voice in payer negotiations, defending savings estimates, attribution methodology, and other term requirements

Team & Organization

• Build and lead the medical economics and reporting function, operating initially as a hands-on individual contributor while developing the hiring roadmap and team structure
• Collaborate with Daymark's actuary team on modeling, trending, and actuarial review
• Serve as an SLT member with a voice in product, clinical, and growth strategy decisions