Medical Economics Manager
CVS Pharmacy - Hartford, CT
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Job DescriptionAs a Medical Economics Manager, you will monitor and support Business review and implementation of Encounter submissions. This is critical to support our provider contracts, and enterprise reporting including ensuring we maximize risk revenue.As part of the Medical Economics Team, you will take ownership of the overall encounter process. You will work collaboratively with our Network negotiators and partners to facilitate onboarding of new groups. In addition, you will also monitor submissions, troubleshoot, and address issues, communicate with clearing houses, track trends, and produce enterprise and provider reporting. You will develop a partnership with SMEs in upstream and downstream business areas to facilitate smooth processing of encounters in mainframe systems to generate complete and adequate risk date and revenues. The position will include working on system enhancements and IT projects impactful to encounter work. The larger Medical Economics Team is accountable for analysis of medical costs across lines of business, supporting data for the right pricing, to develop medical cost savings initiatives and make payments for capitated and Value based incentives. We partner with a wide range of business units across the enterprise including other Medical Economics areas and Contract Negotiators.Pay RangeThe typical pay range for this role is:Minimum: 60,300Maximum: 130,000Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required Qualifications5 or more years of managed care experiencePreferred Qualifications5-6 or more years in the managed care industry with exposure to mainframe processing, claims or other. Ability to work collaboratively with external providers and internal business partners under pressure. Critical thinking, detail oriented, problem solving and communication skills essential. Analytical and problem resolution skills. Knowledge of market-place delivery (understanding of provider relationships)Excel and Microsoft Office applications experienceAbility to communicate internally and externally to providersEducationBachelors degree or equivalent work experience required.Business OverviewBring your heart to CVS Health Every 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. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
Created: 2024-09-07