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 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
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
Financial or actuarial background
Project Management Certification
Preferred work location Louisville KY will consider Work at Home.
Scheduled Weekly Hours