Director of Medical Economics (Mental Wellbeing)

Job DescriptionAs the Director of Medical Economics (Mental Wellbeing), you will provide oversight and leadership of all activities related to Medical Economics - Mental Wellbeing team. The primary goal of this team is to provide timely, accurate, actionable data and analysis for utilization and unit cost management in support of the organization's Mental Well Being strategy.Fundamental Components included but are not limited to: Align with Head of Performance management to set organizational strategy. Develops and presents actionable recommendations to management based on analysis. Manages the aggregate financial impact of contracts to support financial planning and management decisions. Collaborates with Medical Management/OPS/MEU on cost saving opportunities. Works with matrix partners to ensure financial integrity is achieved and maintained from the provider contract to the actual claim adjudication. Participates in research-related activities including industry best practices and experience studies.Required Qualifications 8+ years of experience in managed care contracting and/or analytics (relevant analytical financial experience). 8+ years of experience in the healthcare and/or managed care industry Experience with providing very complex programming and analytical support for medical cost trend analysis and strategic planning, Experience managing data analysis and interpretation Advanced skills in Excel, MS-Access and Web-based query tools (MCM, data warehouse). Ability to manage conflicting priorities and multiple projects concurrently. Advanced SQL programming experienceCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications 8 plus years providing analysis and support for planning and forecasting of medical costs, Information Management Familiarity with key managed care functions including EAP, provider contracting, benefit design, medical management as well as knowledge of business functions and impact on financials (underwriting, sales, product development, network management) is also strongly preferredEducation Bachelor's degree in Actuarial Science, Mathematics, Statistics, or other related field or 12 years of equivalent work experience.Business OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2024-10-19