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Director of Medical Economics
Employment Type:
Full-Time Direct Hire
Category: Executive Level/Administration, Program Director
Job Number: 6933
Job Description
We are assisting an employer in its search for a Director of Medical Economics. This role provides leadership and direction to the Medical Economics Team for the data analysis related to financial performance and clinical trends. This position will consider contractual required managed care efficiencies and savings targets in the drive towards data-informed decisions. This position will work closely with Executive Leadership to develop performance indicators that are cross-functionally utilized. This position will direct the analytical and interpretive work on claims expense and reimbursement data to identify areas for improvement. This position will work with operational departments to recommend cost initiatives that produce positive financial results and better member outcomes.
This position will allow the successful candidate to work a schedule that will be primarily remote and will report to Morrisville, NC, as needed. The successful candidates will be residents of North Carolina or, if currently residing out of state, able to relocate.
Responsibilities & Duties
Oversee Service Spending and Reimbursement Analysis and Improvements
- Oversee monitoring and analysis of service spending and reimbursement trends to identify opportunities for improving financial performance
- Work with the CFO to prepare and present regular financial reports to senior leadership, including forecasting future trends and economic performance of services
- Work with the CFO to develop yearly service budgets based on operational goals and strategic plan. Incorporate collaborative work with the CMO
- Direct implementation and monitoring of Medical Cost Action Plans and other Cost Initiatives
- Use actuarial data to evaluate service performance and evaluate PMPM to be used during State rate negotiations
- Monitor and forecast medical utilization patterns and flag outliers
- Lead statistical analyses to assess the effectiveness of clinical programs and initiatives in collaboration with the CMO or designees
- Coordinate with leadership to incorporate dashboards into business processes. Prepare reports for presentation purposes, including to the Board
- Direct and implement the creation of a sophisticated analytic framework and functional models to forecast lines of service
- Provide leadership in the interpretation of data analysis through SQL code and other similar tools such as Power BI and pivot tables
Collaborate with Departments and Stakeholders on Service Delivery Analytics, Performance, and Cost
- Develop and maintain relationships with key stakeholders
- Collaborate with other departments within the organization to ensure alignment of goals and objectives.
- Work with the Clinical and Network Operations to develop and implement strategies to improve the service delivery performance
- Liaise with Clinical and Network Operations regarding financial implications of utilization and contract structures
- Liaise with IT to assist in the enhancement of data warehouse BI analytics to include components that will help in the evaluation of performance
- Work with the Business Intelligence team to design, validate, and deploy health economics dashboards to support cost reduction, quality of care improvement, patient/plan member satisfaction, and program tracking
- Lead analytic efforts in assisting Provider Networks in the implementation of Value-Based Payment arrangements to monitor care and member outcomes
Manage and Develop Staff
- Work with Human Resources and the EVP-CFO to attract, maintain, and retain a highly qualified and well-trained workforce
- Ensure staff are well-trained in and comply with all organization and department policies, procedures, and business processes
- Organize workflows and ensure staff understand their roles and responsibilities
- Ensure the department has the needed tools and resources to achieve organizational goals and to support employees and ensure compliance with licensure, regulatory, and accreditation requirements
- Actively establish and promote a positive, diverse, and inclusive working environment that builds trust
- Ensure all staff are treated with respect and dignity
- Ensure standards are transparent and applied consistently, impartially, and ethically over time and across all staff members
- Work to resolve conflicts and disputes, ensuring that all participants are given a voice
- Set goals for performance and deadlines in line with the organization's goals and vision
- Effectively communicate feedback and provide ongoing coaching and mentoring to staff and support a learning environment to advance team skills and professional development
- Cultivate and encourage efforts to expand cross-team collaboration and partnership
Lead Performance Committee
- Oversee the Organization Performance Management Committee structure
Promote Innovation and Process Improvement
- Stay current on healthcare industry trends and regulations, and provide expert advice and recommendations to JLT and the Clinical Team
- Stay current on best practices and developments in the field of medical economics, and incorporate these into the organization's processes and systems
- Encourage a culture of continuous improvement within the medical economics team, and lead by example in promoting a culture of innovation
- Identify and execute new projects to improve Health Plan's financial, quality of care, risk adjustment, and clinical outcomes in collaboration with Clinical and Provider Network Operations
- Evaluate and monitor initiatives
Requirements
Bachelor’s degree in business administration, accounting, finance, or related field, and seven (7) years of experience in managed care, performing a broad range of health plan data analysis, including 3 years managing a team.
Or
Master’s degree in business administration, accounting, finance, or related field with 5 years of experience in managed care, performing a broad range of health plan data analysis, including 3 years managing a team
Experience must include presenting to executive leadership; analysis of medical claims, clinical assessments, and EMRs; and knowledge of health plan financial and regulatory reporting standards.
The employer is offering an excellent salary and benefits package.
Please apply on-line or email your resume to Cheryl@psychpros.com for immediate consideration.
Meet Your Recruiter
Cheryl Rapier
Senior Recruiting Manager
I enjoy the linking process - making good matches. My job is to listen to the needs of my clients and find the candidate who most closely matches what they are looking for.
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Ready to take the next step in your career? Explore our job opportunities in the vibrant area surrounding Morrisville, North Carolina! Nestled in the heart of the Research Triangle Park, this region offers an exceptional blend of bustling tech hubs, picturesque green spaces like Lake Crabtree County Park, and a lively cultural scene boasting the North Carolina Museum of Art and the Duke Energy Center for the Performing Arts. Indulge in the area's diverse culinary scene, catch a game at the PNC Arena, home to the Carolina Hurricanes, or simply relax at Umstead State Park. Embrace the charm and endless growth opportunities that Morrisville and its surroundings have to offer - your dream job could be just a click away!