This position is offered in Phoenix, AZ, Irving, TX, Hartford, CT, Atlanta, GA, Cary, NC, Concord, CA, Chicago, IL, Work from Home Flexible in any US State.
As a Medical Economics Manager, you will be providing consultative support and medical cost based analysis of markets and network initiatives. As a Medical Economics Manager, you will be providing consultative support and medical cost based analysis of markets and network initiatives.
The Medical Economics Manager is essential to managing conflicting priorities and multiple projects concurrently.
The Medical Economics Manager 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 and is essential to managing conflicting priorities and multiple projects.
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, working collaboratively with local market leaders 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.
- 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.
- Need experience with medical cost trends and analysis with medical and pharmacy claims
- Working with Excel, MS-Access and Web-based query tools (data warehouse).
- 5 or more years of experience in the managed care industry including of provider contracting, provider reimbursement, patient management, product, or benefits design
- 2 or more years experience within analytics of finance
COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
- 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 and/or SQL Server
Bachelor's Degree or equivalent work experience required
Bring your heart to CVS Health
Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
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