Medical Economics Manager
The Medical Economics Manager within the Clinical Strategy and Efficiency (CSE) team is primarily responsible for providing insights on
costs, utilization and performance metrics to contribute to the success of whole market performance. The Medical Economic Manager serves as a primary consultant to our Market President and Clinical, Network and Operations leadership. This is a role in which we are looking for excited, growth oriented individuals who enjoy making data-driven strategy recommendations in the Medicare Advantage and healthcare industry.
Primary Duties and Responsibilities
Provide independent analysis and insight to markets to constructively challenge their performance and support the annual life cycle of reporting requirements.
- Serve as a market expert and consultant for medical trends, cost drivers and cost saving opportunities.
- Responsible for monitoring profit and loss (P&L) for Medical Costs, and contributing to the market reaching the Medical Cost and Hospital Utilization finance plan and targets. Contribute as a market leader to success of whole market performance.
- Lead projects focused on utilization management trends to help find insights in the data, and work with clinical, network and operational stakeholders to identify opportunities to improve and measure business process effectiveness.
- Monitor data for care management and disease management, and work with local leadership and stakeholders to identify and provide strategies to execute improvement opportunities.
- Coordinate with finance and market leadership a medical costs annual budget and help set yearly utilization targets.
- Prepare and analyzes cost, clinical, and operations data to develop material presented to executive management.
- Track performance of KPI (Key Performance Indicators: financials/operational) for your market.
- Manage provider network costs, by ensuring appropriate coverage and minimizing extra payment costs.
Collaborate with market leadership to develop and implement new strategies and programs that improve overall market profitability
- Leverage data analytics and medical cost modeling to provide insight into new and existing processes and business opportunities. Test and track efficiency of new multi-pronged strategies within the market.
- Act as a data liaison for market leadership and stakeholders. Understand their needs and translate them into reporting and analytic solutions.
- Build strong and trusting relationships with market leaders to support their problem solving and ensure overall awareness of issues and challenges in market. This will require some travel to the market and the ability to work effectively remotely with individuals.
- Educate leadership, physicians and staff members how to effectively use reports and data resource tools.
- Provide data analysis during pre-negotiation stages to support Market Network Directors with data on outside providers.
- Collaborate with Market Directors and President to suggest new service lines such as collaborative psychiatric care and emergency paramedic home visiting based on medical unit costs, utilization and market best practices.
Work collaboratively across ChenMed to strengthen functioning of the enterprise and deepen knowledge, processes and expertise on Medical Economics
- Stay well-informed on effective initiatives that have been deployed in all markets and communicate best practice strategies developed locally across all markets. Support documentation, impact assessment and evaluation of new schemes in order to enable their rapid scaling to other markets.
- Work closely and share process knowledge with CSE strategy analysts to promote consistency and grow core analytical processes within our department.
- Collaborate with BI and IT on improvement of integrated data warehouse strategy and business needs to help establish reporting consistency and alignment with data governance.
- Maintain clear standard operating procedures (SOP) and project-specific documentation of analytical methods used, key decisions, caveats, and data sources.
- Other duties as assigned and modified at supervisor’s discretion
KNOWLEDGE, SKILLS AND ABILITIES:
- Ability to interpret the needs of organization and provide insight through analytics of claims and internal resources.
- A solid academic background (preferably in a quantitative field, such as engineering, business, etc)
- Solid understanding of health economics required.
- Conceptual thinker.
- Analytical, independent worker, and fast learner.
- Proven attention to detail and high level of prioritization, organization and accuracy.
- Ability to manage multiple projects with varying levels of complexity.
- Enthusiastic and positive attitude.
- Ability to prepare, review, and consolidate data findings for Executive Committee.
- Ability to travel within the US (5-10 % travel time).
- Have the drive to develop him/herself and learn the business.
- Be proactive – self-starters.
- Be a good team player.
- Speak/write English fluently.
education / SPECIALIZED KNOWLEDGE requirements:
- Bachelor degree from a top university required, with majors in quantitative fields such as Engineering, economics, finance, mathematics, preferred.
- Five (5) or more years’ progressive experience in finance, accounting or analytics in the health care provider or health care insurance sectors with a focus on medical economics.
- Prior experience in strategy consulting, required.
- Experience in Medicare Advantage data analytics and strategy planning, preferred.
- Mastery of Microsoft office products (Excel, PowerPoint, etc.) and is efficient in the production of content.
- Ability to create or automate process with data is a strong plus (e.g., data driven websites, Programing skills, Power BI, deep knowledge of macros, SQL, etc.).
- Risk Adjusted Coding knowledge or certification a plus.
- Experience with advanced analytical and reporting software (e.g., QlikView, Tableau) a plus