Job Description :
As a Medical Economics – Senior Consultant, you will be providing consultative support and medical cost based analysis of markets and network initiatives. The Medical Economics – Senior Consultant is essential to managing conflicting priorities and multiple projects concurrently. The Medical Economics – Senior Consultant position is responsible for consulting with network and clinical management on opportunities to improve our company's discount position and strategic cost and utilization initiatives.
As part of the Medical Expense Review (MER) team, you will take ownership of your market and analyses, preparing for monthly presentations, and managing both long and short-term projects effectively while working collaboratively with local market leaders and in other inter-departmental settings to accomplish tasks and goals. The Medical Expense Review (MER) team is accountable for developing, interpreting and favorably impacting local market medical cost trend and provide analysis and network actions leading to medical cost improvement.
Additional responsibilites include:
• Analyze and research utilization and unit cost medical costs drivers
• Support the development of scoreable action items by identifying outlier cost issues.
• Perform drill-down analysis to identify medical cost trend drivers; advise network of contracting opportunities to mitigate future trends.
• Own, track and document all aspects of related work from beginning to end of a project.
• Working with Excel, MS-Access and Web-based query tools (data warehouse).
• 3+ years of experience in the managed care industry with knowledge of provider contracting, provider reimbursement, patient management, product, benefits design or related experience.
• 2+ year experience within analytics of finance or related experience
• Experience working with medical and pharmacy Claims
• Experience in within the healthcare industry
• Experience with key managed care functions including provider contracting, benefit design, medical management as well as knowledge of business functions and impact on financials (underwriting, sales, product development, network management)
• Experience with SAS Enterprise Guide
• Verifiable high school diploma
• Bachelor's degree preferred
At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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