Medical Economic Manager

Join to apply for the Medical Economic Manager role at Presbyterian Healthcare Services

9521 San Mateo NE, Albuquerque, New Mexico , United States of America

Minimum

Offer:

$89,585.60;
Maximum

Offer:

$

Build your Career. Make a Difference. Presbyterian is hiring a skilled Medical Economic Manager to join our team.

Full time

Yes

Reverend Hugh Cooper Administrative Center

Days (United States of America)

Presbyterian is seeking a talented 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. The role will work closely with pricing, clinical operations, provider network, provider contracting, and finance to interpret, analyze, communicate and provide strategies related to the overall plan results of a specific product line (i.e., Commercial,
Medicare, Medicaid
). Responsibilities include identifying medical and pharmacy cost trend drivers, including but not limited to the impacts from clinical programs, contracting changes, provider network changes, geographic variation,
medical cost initiatives
, and underlying population health. Identify opportunities for potential cost savings/revenue enhancements/profitable growth opportunities.

• Acts as a consultant role in helping to set the strategy benefit design and pricing, as the financial expert within each product line.
• Proactively prioritizes financial time‑sensitive requests for information with finite resources.
• Presents complex information in a compelling/articulate format and conducts ongoing performance and analytic reviews with cross‑functional teams, including senior leadership and Medical Directors.
• Conducts 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 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).

• Bachelor’s degree in healthcare, accounting, finance, or other quantitative/related field.
• 6 years of healthcare industry experience specifically in medical economics/ interpreting/ analyzing product performance.
• Must have solid knowledge of most aspects of health plan operations and direct analytics experience working with areas including 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 ICD‑9/10, CPT codes, HCPCS codes, MS‑DRG, ETGs, RBRVS, utilization per K, PMPM, etc.
• Technical skills: strong proficiency in Microsoft Office Applications (Excel, Access, Word, PowerPoint) and experience using analytical/reporting applications such as Business Objects or other BI tools; experience preparing PowerPoint presentations/visualization of complex information in a simplified yet powerful manner.

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.

Presbyterian’s Employee Wellness rewards program provides engaging opportunities to enhance health and well‑being. Earn gift cards and more by taking an active role in personal well‑being through wellness challenges, webinars, preventive screening and more.

As an organization, we are committed to improving the health of our communities. From hosting Growers’ Markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not‑for‑profit healthcare system of nine hospitals, a statewide health plan and a growing multi‑specialty medical group. Founded in New Mexico in 1908, we are the state’s largest private employer with nearly 14,000 employees — including more than 1,600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

Our culture is one of knowing and respecting our patients, members, and each other. We capture this in our Promise and CARES commitments. AA/EOE/VET/DISABLED. PHS is a drug‑free and tobacco‑free employer with smoke‑free campuses.