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Medical Economics Senior Manager
| Company | CVS Health |
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| Location | Pennsylvania, USA |
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| Salary | $75400 – $165954 |
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| Type | Full-Time |
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| Degrees | Bachelor’s |
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| Experience Level | Senior |
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Requirements
- 7+ years of prior experience in the industry with decision support, including presentation skills for provider (EXTERNAL) and business partners with less financial/technical skillsets
- 5+ years of SAS and SQL skills to pull custom data for analysis
- Bachelor’s degree in Math, Actuarial Science, Economics or another related degree preferred/specialized training/relevant professional qualification or equivalent (HS Diploma and 4 years of experience) required
Responsibilities
- Supporting complex Capitation analyses that support strategic goals for Medicaid, Medicare, IFP and commercial
- Working collaboratively with the Network to determine the financial impact resulting from changes in provider contracts and payment methodologies
- Providing focused analytical research, complex financial modeling and business decision support related to medical cost
- Owning complex provider contracts and following through full life cycle from pricing, implementing rates, auditing, monitoring leakage, etc.
Preferred Qualifications
- Organization skills to keep projects on schedule and tracking results
- Expertise in multiple areas of provider contracting/reimbursement, analysis, modeling & reporting; Extensive & diverse knowledge of healthcare data, metrics & coding structures
- Understanding of both Commercial and Medicare plans to help network partners to make sound decisions to drive solutions
- Present complex information in a way that multiple levels within an organization can understand and utilize to make appropriate decisions to meet business objectives
