Medical Economic Manager

Now hiring a Medical Economic Manager

Remote: Open to remote applicants in the United States, except for the following states: Wyoming, North Dakota, and Ohio

This position will play a consultative role in helping to set the strategy and pricing and will be the financial expert within the product line. Position will work closely with pricing, clinical operations, provider network, provider contracting, and finance. Interpret, analyze, communicate and provide strategies related to the overall plan results of for a specific product line (i.e. Commercial, Medicare, Medicaid). Highly experienced medical economics analyst will use data from various sources to holistically analyze and communicate health plan performance for a specific product line, including how programs and strategies have influenced performance. Analyze emerging medical cost trends, understand patterns, draw conclusions and provide overviews to tell the story of emerging financial results/profitability for a specific product line. Will include identifying medical and pharmacy cost trend drivers, including but not limited to, impacts from: clinical programs, contracting changes, provider network changes, geographical variation, medical cost initiatives and underlying population health. Identify opportunities for potential cost savings/revenue enhances/profitable growth opportunities.

How you belong matters here.

We value our employees' differences and find strength in the diversity of our team and community.

At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.

Why Join Us

• Full Time - Exempt: Yes
• Job is based Remote
• Work hours: Weekday Schedule Monday-Friday
• Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.

Ideal Candidate:

• Masters Degree
• knowledge of most aspects of health plan operations and direct analytics experience working with most areas including but not limited to: medical management programs, population health programs, utilization management, care coordination, reimbursement methodologies, provider contracting including incentive strategies and value based reimbursement, claims payment, system configuration, sales/employer group reporting, premium development, finance and actuarial.

• Bachelors degree in healthcare, accounting, finance or other quantitative/related field.
• 6 years healthcare industry experience specifically medical economics/ interpreting/ analyzing product performance.
• Must have solid knowledge of most aspects of health plan operations and direct analytics experience working with most areas including but not limited to: medical management programs, population health programs, utilization management, care coordination, reimbursement methodologies, provider contracting including incentive strategies and value based reimbursement, claims payment, system configuration, sales/employer group reporting, premium development, finance and actuarial.
• Solid knowledge of healthcare industry and healthcare information standards such as ICD9/10, CPT codes, HCPCS codes, MS-DRG, ETGs, RBRVS, Utilization per K, PMPM, etc.
• Technical Skills: must possess strong technical skills in Microsoft Office Applications (Excel, Access, Word, PowerPoint) as well as experience using analytical/reporting applications such as Business Objects or other BI tools. Experience preparing Power Point presentations/ visualization of complex information in a simplified yet powerful manner.

• Acts as a consultant role in helping to set the strategy benefit design and pricing, as the financial expert within each product line.
• Proactively prioritize financial time-sensitive requests for information with finite resources.
• Present complex information in a compelling/articulate format/manner and will conduct ongoing performance and analytic reviews with a cross functional teams, including senior leadership and Medical Directors.
• Conduct research on health economic issues and trends and benchmarks. Educates internal and external customers on healthcare costs, utilization, and trends and how they relate to the effective management
• Reviews monthly reserve analysis (IBNR) and provides input regarding emerging trends, contract changes and other drivers of trend that could impact the monthly reserve analysis (IBNR).
• Responsible for setting and measuring product performance against budget and re-projection. Ensures that assumptions are consistent with membership and revenue assumptions.
• Provide some mentoring and training to others in departments as we as business partners as needed.

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

Inclusion and Diversity
Our culture is one of knowing and respecting our patients, members, and each other. We capture this in our Promise and CARES commitments.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.