Associate Director Medical Economics - Remote

Profile

Description

The Associate Director, Medical Economics for the Primary Care Organization within the Population Health Team is responsible for working collaboratively with clinical, operational, and financial leadership to identify and leading medical cost saving initiatives that contribute to the success of Centerwell and Conviva's financial performance.

Responsibilities

About Us

The Primary Care Organization (PCO), is looking for high potential candidates who are looking to accelerate their career development and contribute to driving disruption in the health care industry. The PCO provides primary care medical group practice with centers open or opening in Florida, Georgia, Kansas, Louisiana, Missouri, Nevada, North Carolina, South Carolina and Texas. The PCO has a strong emphasis on senior-focused primary care for members of Medicare Advantage health plans and is committed to providing personalized, high-quality primary care combined with an excellent patient experience.

At PCO we want to help those in the communities we serve, including our associates, lead their best lives. We support our associates in becoming happier, healthier, and more productive in their professional and personal lives. We promote lifelong well-being by giving our associate fresh perspective, new insights, and exciting opportunities to grow their careers. Our culture is focused on teamwork and providing a positive and welcoming environment for all.

We have over 215 clinics nationwide and counting - come join us.

The Role

The Associate Director, Medical Economics will work with regional clinical and operational dyad partners to make data-driven strategy recommendations to bend medical cost trends contributing to the financial success of the organization.

Responsibilities

Leads a team of cost and use strategic advancement advisors.

Partners with finance, business, and clinical executive leaders to create benchmarks to monitor medical cost trends and variances. Assists in the design and evaluation of company KPIs to support long term goals.

Supports finance in the long-term planning process including development of medical cost targets, key metrics, and projections.

Builds strong and trusting relationships with clinical and operation dyad leaders at local and regional levels to support problem resolution and ensure overall awareness of medical cost issues and challenges.

Collaborate closely with the leadership of the primary care organization data and application team to validate data, enhance reports and tools, and help design new products for market consumption.

Prepares and analyzes cost, clinical, and operations data to develop material presented to executive management. Interpret results and articulate actionable recommendations that maximize profitability and ensure trend bending targets are achieved.

Stays up to date of changing healthcare landscape to maintain an awareness of CMS and Payor developments impacting medical costs.

Identify opportunities to measure and improve business process effectiveness thru data-driven insights of cost and utilization.

Lead all trend bender initiatives, including tracking deliverables, timelines, and holding stakeholders accountable to drive targeted outcomes.

Leverages data analytics and modeling to test, validate and track return of investment of existing and proposed medical cost strategies and initiatives.

Vaccine Policy

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters.

Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Required Qualifications

Bachelor's degree in Finance, Data Analytics or Economics or related field

Previous management experience, supporting and driving healthcare strategy

A Minimum of five years of related experience in data analysis role focusing on medical costs and/or claims

Minimum three years of experience managing strategic projects and cross functional teams.

Experience in a Medicare Advantage, Hospital Systems and/or risk-based healthcare organization

Ability to analyze claims data to interpret cost and utilization metrics that identifies Medicare Part A, B and D opportunities among each specialty for actionable insights

Proven ability to synthesize and summarize complex and/or voluminous content into clear, concise and actionable communications

Experience effectively identifying, developing, and implementing process improvements; to include 'outside of the box' solutions

Excellent in building and cultivating relationships with key business partners and stakeholders across organizational levels

Ability to interpret the needs of the organization and communicate actionable insights through analytics

Excellent verbal, interpersonal, and written communication skills

Advanced Microsoft Excel skills including statistical modeling, vlookup and pivot tables

Preferred Qualifications

Master's degree in Business or related field

Experience with PowerBI and SQL query writing

Ability to model financial concepts of ROI, IRR, etc

Extensive knowledge of medical economics data such as hospital/physician /ASC claims, utilization data, and healthcare industry coding systems ICD-10, CPT/HCPCS, Revenue Codes, MS/APR-DRGs and APCs

Additional Information

This is a remote position; we are targeting candidates who reside in: TX, GA, FL, or KY. These are preferred locations.

<25% Monthly travel to specific markets: Houston, Atlanta, Florida, and/or Louisville

Hours: 8-5 (M-F) Central or Eastern Time Zone

#LI-Remote

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com