Description

Why We Need You – The Mission

Healthcare quality is complex. Medisolv helps make it manageable—and actionable.

We partner with hospitals, health systems, ACOs, and payers to bring clarity to quality data, connecting clinical and claims information into a single, reliable view. More than 1,800 organizations and 130M+ patient records rely on Medisolv to measure, report, and improve performance across 500+ measures tied to CMS, The Joint Commission, and other programs.

With support from Bessemer Venture Partners Forge, we’re continuing to grow our platform and expand our impact—investing in advanced analytics, AI, and new capabilities that help healthcare organizations stay ahead of change and improve outcomes with confidence. If you know the health insurance and VBC worlds inside out, understand the math behind CMS quality calculations, and you're genuinely excited about putting autonomous AI agents to work on messy healthcare data, we want you on the team.

What You’ll Accomplish – Your Performance Objectives

First 30 Days – Foundation & Alignment

Build a deep understanding of Medisolv’s data ecosystem and CMS measure logic (HEDIS, Pharmacy, CAHPS/HOS).
Align with engineering, AI, and clinical stakeholders on priorities and high-impact use cases.
Define initial AI agent architecture and guiding principles for HITL safety and compliance.

First 3 Months – Design & Prototype

Design and prototype AI agents to identify care gaps and predict Star Rating risks.
Stand up the foundation of the payer data core from fragmented datasets.
Develop initial CMS measure calculation engines and pilot action-oriented workflows.

First 6 Months – Launch & Scale

Deploy production-ready AI agents that connect insights directly to gap-closing actions.
Expand and stabilize the payer data core and measurement automation.
Implement orchestrated workflows and mature HITL guardrails.

First 12 Months – Optimize & Drive Outcomes

Optimize AI performance with feedback loops and expand to more advanced use cases.
Mature the data platform into a scalable, real-time decisioning engine.
Drive measurable improvements in Star Ratings and value-based care outcomes.

Who We’re Looking For - The Competencies That Matter

Payer & VBC Domain Fluency: You have 5+ years of product management experience handling health plan data and VBC provider quality metrics. You deeply understand risk adjustment, utilization management, and how risk‑bearing entities operate.
CMS Quality & Star Ratings Expertise: You know how CMS calculates MA Star Ratings inside out. You understand the math behind cut points, the impact of triple‑weighted measures, and how to build data products that move the needle across various CMS measure domains.
Deep Comfort with Core Payer Data: You speak the language of payer operations. You have hands‑on experience working with claims, eligibility, and enrollment datasets, and you know how to map these back to quality performance.
A "Beyond-the-Dashboard" Mindset: You are tired of building static BI tools. You want to build proactive software that thinks, adapts, and automates workflows rather than just reporting on them.
AI & Data Literacy: You don't need to write the code, but you must understand GenAI architectures, RAG, and agentic frameworks (like LangChain, AutoGen, or similar orchestration toolsets). You are comfortable talking to engineers about vector databases, APIs, and semantic data layers.
Trust & Security First: You understand that healthcare data requires extreme care. You know how to build within HIPAA/HITRUST guidelines and ensure AI outputs are accurate, unbiased, and explainable.
You are a doer. You take initiative and enjoy driving tasks from inception to completion. You probably have a strong bias for action and may even become frustrated when things come to a stalemate. You use this frustration in a positive manner to drive towards a solution to move things forward.
Collaborative. You have empathy for your colleagues. You demonstrate and influence cross‑functional collaboration within the company and seek out opportunities to build relationships with others even when difficult personalities or politics stood in the way.
Flexibility. You understand that at growth stage companies, things will evolve, and you may have to be flexible in your approach and in your expectations. You are open‑minded and adapt well to changing environments as a company grows and scales.
Growth Mindset. You love a challenge. You are intellectually curious and love to figure out how things work. You have a diverse set of interests inside and outside of work. You can articulate areas where you have worked hard on improving yourself over time.
Resilient. You embrace change. You are optimistic. It’s not how many times you get knocked down, it’s how many times you get up.

How to be a Medisolver – Our Values

Customer Success Obsession
All-Star Team Collaboration
Continuous Improvement through Curiosity & Data-Driven Learning
Courage with Kindness
Execution Focus. We Do Business, Not Just Talk Business

Medisolv is committed to creating a diverse and inclusive workplace. We believe that diversity drives innovation, and we are dedicated to fostering an environment where all employees feel valued and respected.

Candidates must successfully complete a pre-employment background check and be legally authorized to work in the United States, as sponsorship is not available.

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