Medical Economic Manager

Overview

Now hiring a Medical Economic Manager

This position will play a consultative role in helping to set the strategy and pricing and will be the financial expert within the product line. Position will work closely with pricing, clinical operations, provider network, provider contracting, and finance. Interpret, analyze, communicate and provide strategies related to the overall plan results of for a specific product line (i.e. Commercial, Medicare, Medicaid).

Highly experienced medical economics analyst will use data from various sources to holistically analyze and communicate health plan performance for a specific product line, including how programs and strategies have influenced performance. Analyze emerging medical cost trends, understand patterns, draw conclusions and provide overviews to tell the story of emerging financial results/profitability for a specific product line. Will include identifying medical and pharmacy cost trend drivers, including but not limited to, impacts from: clinical programs, contracting changes, provider network changes, geographical variation, medical cost initiatives and underlying population health.

Identify opportunities for potential cost savings/revenue enhances/profitable growth opportunities.

We're determined to take care of those working in healthcare.

Presbyterian is dedicated to improving people's lives - the lives of our patients and the lives of our coworkers. We're a locally owned and operated, which encourages supportive leadership that empowers employees. And we provide the opportunity to grow from entry-level to the most senior positions.

Why Join Us

• Full Time - Exempt:
  Yes
• Rev Hugh Cooper Admin Center
• Work hours:
  
  Weekday Schedule Monday-Friday
• Benefits:
  We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.

Ideal Candidate:

• Masters Degree
• knowledge of most aspects of health plan operations and direct analytics experience working with most areas including but not limited to: medical management programs, population health programs, utilization management, care coordination, reimbursement methodologies, provider contracting including incentive strategies and value based reimbursement, claims payment, system configuration, sales/employer group reporting, premium development, finance and actuarial.

• Bachelors degree in healthcare, accounting, finance or other quantitative/related field.
• 6 years healthcare industry experience specifically medical economics/ interpreting/ analyzing product performance.
• Must have solid knowledge of most aspects of health plan operations and direct analytics experience working with most areas including but not limited to: medical management programs, population health programs, utilization management, care coordination, reimbursement methodologies, provider contracting including incentive strategies and value based reimbursement, claims payment, system configuration, sales/employer group reporting, premium development, finance and actuarial.
• Solid knowledge of healthcare industry and healthcare information standards such as ICD9/10, CPT codes, HCPCS codes, MS-DRG, ETGs, RBRVS, Utilization per K, PMPM, etc.
• Technical
  
  Skills:
  
  must possess strong technical skills in Microsoft Office Applications (Excel, Access, Word, PowerPoint) as well as experience using analytical/reporting applications such as Business Objects or other BI tools. Experience preparing Power Point presentations/ visualization of complex information in a simplified yet powerful manner.

• Acts as a consultant role in helping to set the strategy benefit design and pricing, as the financial expert within each product line.
• Proactively prioritize financial time-sensitive requests for information with finite resources.
• Present complex information in a compelling/articulate format/manner and will conduct ongoing performance and analytic reviews with a cross functional teams, including senior leadership and Medical Directors.
• Conduct research on health economic issues and trends and benchmarks. Educates internal and external customers on healthcare costs, utilization, and trends and how they relate to the effective management
• Reviews monthly reserve analysis (IBNR) and provides input regarding emerging trends, contract changes and other drivers of trend that could impact the monthly reserve analysis (IBNR).
• Responsible for setting and measuring product performance against budget and re-projection. Ensures that assumptions are consistent with membership and revenue assumptions.
• Provide some mentoring and training to others in departments as we as business partners as needed.

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness Presbyterian's Employee Wellness rewards program is designed to provide you…