Manager, Medical Economics

The Manager, Medical Economics (MME) manages and provides direct oversight of medical economics team activities and personnel. Provides technical expertise and manages relationships with operational leaders and staff. Responsible for subordinate staff in terms of time-keeping, performance coaching, development, and all other aspects of human resource requirements.

The MME is charged with (1) Identifying cost savings opportunities and leading actuarial analysis related to short and long term cost reduction opportunities, (2) ensuring opportunities are accurately measured, communicated to Senior Management and integrated into pricing, and IBNR, (3) Responsible for the strategy, design, ensuring accuracy of applications and tools used by Medical Economics/Actuarial needed to perform benchmarking analysis, pricing models, and financial analysis, (4) Responsible for the design, implementation, and accuracy of analysis supporting provider contracting (including alternative payment methods, value based programs, capitation, and pay for performance), (5) Responsible for the design and development of tools and analysis to support pro-active and retrospective provider payment accuracy and integrity (6) Responsible for spear-heading analytics to support outcomes reporting

Essential Functions & Responsibilities

    • Develop and lead health care data analysts within the organization’s Medical Economics Unit, through the use of formal training, a wide range of analytics assignments, coaching, mentoring and other development techniques.
    • Responsible for supporting the design, development, and distribution of database tools and applications to efficiently measure, monitor, and/or forecast medical cost structure.
    • Develops and presents actionable recommendations to management based on analysis.
    • Builds best practices and provides analytical support senior leadership.
    • Manages the overall financial impact of contracts to support financial planning and management decisions.
    • Responsible for contractual financial reconciliation language, including per member per month rate adjustment triggers.
    • Builds corporate knowledge of all financial aspects of existing Medicare, Medicaid, Commercial, and Healthy Kids (CHP) programs.
    • Assist with modeling of new business requirements and projects to ensure financial viability and contract options.
    • Advanced organizational and project management skills, excellent team communication skills; experience with large scale analytics and modeling projects.
    • Ability to understand complex business processes and requirements, as well as conveyance of that understanding to subordinates.
    • Ability to safely and successfully perform essential job functions consistent with the ADA, FMLA, and other federal, state, and local standards, including meeting qualitative and/or quantitative productivity standards.
    • Ability to maintain reasonably regular, punctual attendance consistent with the ADA, FMLA, other federal, state, and local standards, and company attendance policies and procedures.
    • Compliance with all personnel policies and procedures.
    • Perform additional duties and related essential duties as assigned.

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Required Education and Experience

  • Four-year degree or equivalent experience preferred; Economics/Mathematics preferred
  • Health care business experience strongly preferred
  • Data Modeling

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