Medical Economics Consultant

Medical Economics Consultant

HealthCare Support is actively seeking a Medical Economics Consultant to fill an opening with one of the nation’s largest managed care organizations.

This is a primarily remote role with an in-office expectation once a month outside of training.

Daily Responsibilities for Medical Economics Consultant :

Evaluate the financial performance of company products such as Commercial, Medicare, and Medicaid. Identify both positive and negative trends, and formulate recommendations to enhance favorable trends.

Effectively communicate these recommendations to the management team.

Generate insights and recommendations based on your analysis and deliver high-level presentations to educate stakeholders and garner support for necessary changes.

Conduct in-depth analyses of claims trends, focusing on actionable items related to cost and utilization measures across member and provider demographics and various cost categories.

Provide data-driven analytics to multiple teams, including Medical Management, Network, and other departments, facilitating informed decision-making.

Support Financial Analysis projects associated with initiatives aimed at reducing medical and provider costs.

Take the lead in completing projects by contributing to ad-hoc data analyses, developing financial reports, and acting as a subject matter expert in creating financial models.

Evaluate the impact of provider reimbursement changes, encompassing contract modifications with hospitals, ancillary services, and physicians.

Create reports that analyze cost trends at the provider level and communicate recommendations to HNS teams, including Network Contracting and Care Management.

Develop, maintain, and automate reporting using a combination of analytical and financial analysis techniques.

Lead the Healthcare Management Reporting process, collaborating with analytics and actuarial teams. This process involves presenting and understanding P&L performance, including variance analysis, revenue details, medical cost breakdowns, performance of Medical Cost Action Plans, product mix, and financial results by market segment.

Take accountability for leading projects and initiatives that drive overall performance and engage in enterprise-wide interaction with business leaders and subject matter experts.

Required Qualifications for Medical Economics Consultant :

• High School Diploma / GED required
• 8+ years of experience in healthcare or managed care with experience in Financial Planning & Analysis (FP&A) and / or Medical Cost Management & Analysis
• 5+ years of experience in developing complex financial models
• 5+ years of experience using data analysis tools such as SQL, SAS and Excel
• Strong interpersonal communication skills

Benefits for Medical Economics Consultant :

• Medical Dental Vision
• PTO & Paid Holidays
• 401K eligibility with generous employer match
• Other Company Perks Available

Pay Details : $95k - $125k / yr heavily dependent on experience and qualifications