[Hiring] Senior Advisor - Payment Design @ORAU

Role Description

ORAU 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 Purpose: To 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

• 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.

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.