Medical Economics And Analytics Lead

Humana Inc. Louisville , KY 40202

Posted 2 weeks ago

Description

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.

Responsibilities

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
40


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
lc_ad

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
Associate Vice President Of Healthcare Economics

Humana Inc.

Posted 1 week ago

VIEW JOBS 4/13/2019 12:00:00 AM 2019-07-12T00:00 Description The AVP of Healthcare Economics will serve as key liaison between operations and actuarial /finance to ensure accurate pricing of trend bender impact as well as assessment of execution risk and estimation error. The primary responsibility of this group is to analyze Humana's business practices for purposes of decision support, business strategy, modeling/forecasting, and to identify cost reduction strategies and improve health outcomes for our members. Responsibilities * Lead healthcare analytics for ROI Studies and Trend Scorecard * Development of quarterly and monthly Trend Scorecards for all Line of Businesses (LOB) * Create and foster a culture of measurement, developing insights, and learning throughout the product organization and company * Lead ROI analysis for all clinical programs and other management initiatives with focus on identification of opportunities to drive better outcomes or gain efficiencies to improve ROI. Ensure studies are designed to appropriately test and learn and operators are held accountable to drive action from the studies * Serve as primary representative from Trend Analytics and Forecasting (TAF) on Trend Summits and Trend Committees for all Line of Businesses; identify and communicate ideas * Oversee the portfolio of analytical work, drive prioritization, execution and communication of that work to stakeholders within and outside growth * Build relationships and partnerships with leadership in Operations, Pricing, and Segment Presidents * Understand both the financial structure of every Line of Business as well as operational areas and how they will impact financials. Identification of opportunities to drive trend benders and program optimization and the ability to work these opportunities across the enterprise to drive results. Required Qualifications * Bachelor's degree required; FSA or PhD in Statistics preferred * 10+ years of experience in healthcare with a focus in analytics, statistical modeling, claims/clinical operations, and/or related experience * Medicare and Managed care experience is required, preferably within Healthcare Economics * Competencies such as big-picture visualization, critical thinking and sequencing * Background in statistical modeling and evaluation methods * Advanced level proficiency with SAS and analytics tools * Exceptional presentation skills and professional communication with the ability to communicate the business impact and financial implications Scheduled Weekly Hours 40 Humana Inc. Louisville KY

Medical Economics And Analytics Lead

Humana Inc.