Job Summary:
The Manager, Medical Economics serves as the leader, subject matter expert, teacher and mentor of the Medical Economics team.
Essential Functions:
- Lead and participate in efforts to analyze and assess healthcare utilization and cost trends, variation and outliers
- Lead and participate in efforts to identify, quantify and prioritize opportunities to reduce medical cost
- Ensure the timely and accurate measurement outcomes related to medical cost reduction initiatives
- Lead and participate in the development of provider network evaluation tools and strategies to improve performance
- Perform any other job related instructions, as requested
Education and Experience:
- Bachelor’s Degree in Mathematics, Economics, Business or related field or equivalent years of relevant work experience is required
- Minimum of five (5) years of experience with healthcare analytics required (health plan preferred)
- Minimum of three (3) years of experience in leading analytic teams or equivalent
Competencies, Knowledge and Skills:
- Proficient in MS Excel, PowerPoint and Word
- Proficient in SAS or SQL
- Exceptional analytical, problem solving and critical thinking skills
- Ability to lead in a hands-on capacity
- Ability to work collaboratively with all levels of management
- Ability to lead mission-critical, high visibility projects
- Ability to manage multiple priorities within a dynamic environment
- Mature written and verbal communications skills
- Knowledge of managed care operations and finance
- Knowledge of fee for service and value based provider reimbursement methods
- Knowledge of government healthcare programs (Medicaid, Medicare Advantage required/Marketplace, MSSP ACO preferred)
- Knowledge of the fundamentals of pharmacy benefit management and pricing
- Knowledge of healthcare quality programs and measures (e.g. CMS, HEDIS, NCQA, AHRQ)
- Extensive knowledge of health care coding and billing including CPT-4, HCPCS, ICD-9/10, DRG, Revenue Codes and NDC)
Licensure and Certification:
Working Conditions:
- General office environment; may be required to sit or stand for extended periods of time
Compensation Range:
$90,500.00 - $158,400.00
CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.
