Medical Economics And Analytics Lead

Humana Inc. Chicago , IL 60602

Posted 2 weeks ago


The Medical Economics and Analytics Lead is responsible for the identification and management of financial and clinical opportunities for the Care Delivery markets. This includes financial analysis, data analysis, medical expense tracking and trending and clinical outcomes. The lead will work collaboratively to ensure the organization is focused on current clinical results vs. the market, current operating performance trends, and the identification and execution of initiatives to manage medical expense and revenue. Provide leadership and strategic vision in transforming business intelligence into action plans and providing strategic recommendations to improve our care model and financial outcomes. This position will also over the support of the Care Delivery Delegated Utilization program through data and analytics.


Essential Functions and Duties

  • Responsible for and the identification and management of financial and clinical opportunities for the Care Delivery markets.

  • The lead will work collaboratively with corporate and market leadership to ensure the organization is focused on current results versus market and budget, current operating performance trends, and the identification and execution of initiatives to manage medical expense and revenue.

  • Provide leadership and strategic vision in transforming business intelligence into action plans and providing strategic recommendations to improve our care coordination plan performance measurement, pricing utilization and population management.

  • Develop mechanisms to report and provide feedback on operating performance. Coordinates analyses of medical costs and is proactive in recommending changes to enhance revenue and manage medical costs.

  • Develop long and short-term goals and objectives. Ensure objectives are consistent with larger population health strategy.

  • Produce reports and other tools to help with execution of initiatives, track results and provide feedback and additional opportunities to clinical and operational leaders.

  • Work in conjunction with outside provider partners to provide analytical support.

Supervisory Duties:

Supervisory duties may include but are not limited to:

  • Management of UM support team and market support teams.

  • Approval of any time off requests.

  • Directly responsible for the prompt completion of the annual evaluation of employees assigned to his/ her team.

  • Screen and interview potential candidates for the department.

  • Responsible for overseeing the day to day operations of his/ her team.

  • This position has the authority to make suggestions and recommendations as to hiring, firing or other change of status of employees under his/ her supervision

Required Qualifications

  • Bachelor's Degree in Business, Finance, Math or related field required

  • Minimum of 5 years of relevant work experience with a minimum of 3 years' experience in healthcare; optimal 5-10 years of relevant experience

  • Minimum of 3 years of management experience with significantly increased levels of responsibility.

  • Knowledge of health insurance industry, especially managed care

  • Experience in managing data to support and influence decisions on day-to-day operations, strategic planning and specific business performance issues

  • Experience in compiling, modeling, interpreting and analyzing data in order to identify, explain, influence variances and trends

  • Able to analyze various healthcare data and providing medical cost analysis.

  • Explains variances and trends and enhances modeling techniques

  • Knowledge of statistical analysis and statistical

  • Highly proficient in Microsoft Excel; working knowledge of SQL and MS Access.

  • Must be able to exercise independent judgment and decision making on complex issues regarding job duties

  • Ability to work under minimal supervision

Preferred Qualifications

  • Master's Degree

  • Financial or actuarial background

  • Project Management Certification

Additional Information:

Preferred work location Louisville KY will consider Work at Home.

Scheduled Weekly Hours

icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Medical Economics Manager

Aetna Inc.

Posted 1 week ago

VIEW JOBS 4/13/2019 12:00:00 AM 2019-07-12T00:00 Job Description POSITION SUMMARY Lead consultative and analytics point of contact for Joint Venture company/market. Accountabilities include project initiation, identification and completion of key deliverables to ensure all business objectives are met. Responsible for the development and implementation of key medical economics business efforts (e.g. medical cost initiatives, policies/programs and analytical models). Accountable for all financial projections associated with project. Fundamental Components: Senior team member for analytical modeling and consulting on Joint Venture company/market. Role involves independent analysis, coach others and working collaboratively with business units across the company and be part of a team that provides medical cost and outcomes focused analytical research, complex financial modeling and business decision support reporting. Performs analyses of varied healthcare data to evaluate programs and product solutions using healthcare medical, pharmacy, lab, survey and utilization data. Requires strong communication skills creating an environment of teamwork with internal Aetna and external provider constituents. Presents complex information in a way that multiple levels within an organization can understand and utilize to make appropriate decisions to meet business objectives. Motivated and is willing to understand and probe into data. Contributes to a positive environment by working effectively to achieve common goals. Must be skilled in complex financial data collection, modeling & analysis, advanced use of Microsoft Excel and SAS, understand relational database concepts and related query tools. Capable of taking project through issue identification, design specifications, data query/programs, financial analysis and resolution/recommendation stages. Demonstrates critical thinking and expresses ideas clearly, concisely and logically from a cross functional perspective. Ability to manage conflicting priorities and multiple projects concurrently. Demonstrates initiative, innovation and leadership in achieving results. BACKGROUND/EXPERIENCE desired: 7-10 years demonstrated leadership and project management experience. Ability to manage conflicting priorities and multiple projects concurrently. Strong analytical ability and familiarity with advanced financial and healthcare concepts. Advanced software and programming skills will be required in different MEU departments EDUCATION The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience. FUNCTIONAL EXPERIENCES Functional - Information Management/Business information analysis/7-10 Years Functional - Finance/Financial analysis/4-6 Years Functional - Communications/Translating & Interpreting/7-10 Years Functional - General Management/Data analysis & interpretation/7-10 Years TECHNOLOGY EXPERIENCES Technical - Desktop Tools/TE Microsoft Excel//Power User Technical - Database///End User Technical - Modeling///End User Technical - Reporting Tools/SAS/7-10 Years/ Telework Specifications: Full-Time Telework (WAH) Part-Time Telework (ex: 2 days office-based, 3 days telework) ADDITIONAL JOB INFORMATION Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come. We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence. Together we will empower people to live healthier lives. Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities. We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard. Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Aetna takes our candidates's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately. Aetna Inc. Chicago IL

Medical Economics And Analytics Lead

Humana Inc.