Medical Economics Manager

Job DescriptionThe Medical Economics Manager will: Leads complex medical economic projects related to Value Based Contracting. Accountabilities include project initiation, identification and completion of key deliverables to ensure all business objectives are met. Oversees the development and implementation of key medical economics business efforts (e.g. medical cost initiatives, policies/programs and analytical models). Accountable for all financial projections associated with project. Oversees the both standard and ad-hoc reports, analytical modeling, and consulting on provider specific negotiations related to Value Based Contracting programs. Partners and consults with Actuarial, Network, Patient Management and Engagement Management teams to provide medical cost analysis to assess effectiveness of managing costs creating and implementing plans to effectively manage medical costs based on analysis or trends. This includes both contractual reconciliation and ad hoc consulting supporting. Performs analyses of varied healthcare data to evaluate programs and product solutions using healthcare medical, pharmacy, lab, survey and utilization data. Requires strong communication skills creating an environment of teamwork with internal Aetna and external provider constituents Conducts stop loss reviews and supports overpayment and recovery efforts. Participates as subject matter expert in provider negotiations including support for proposals along with reviewing interim reports with markets and providers regarding progress towards goals. Work both independently and collaboratively with business units across the company and be part of a team that provides medical cost and outcomes focused analytical research, complex financial modeling and business decision support reporting.Required Qualifications5 or more years of experience in health care delivery systems role and/or financial analytics with accountability for business results.COVID 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 QualificationsUnderstand relational database concepts and related query tools. Capable of taking project through issue identification, design specifications, data query/programs, financial analysis and resolution/recommendation stages.Presents complex information in a way that multiple levels within an organization can understand and utilize. Works collaboratively with other Consultants and Analysts as well as coaching others. Motivated and is willing to understand and probe into data. Contributes to a positive environment by working effectively to achieve common goals. Must be skilled in complex financial data collection, modeling & analysis, advanced use of Microsoft Excel.EducationBachelor's Degree or equivalent work experience requiredBusiness 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: 2024-11-02