Executive Director- Medical & Healthcare Economics

Presbyterian Healthcare Services

About The Position

The Executive Director of Medical & Healthcare Economics serves as a strategic enterprise leader, driving the transformation of care delivery and financial performance across the health plan and the integrated health system. This executive role is accountable for architecting and advancing medical economics capabilities, shaping reimbursement and policy strategies that align with organizational goals. Through deep collaboration with clinical, actuarial, financial, and operational leaders, the VP ensures that economic insights translate into actionable strategies that enhance quality, reduce cost, and improve member outcomes. The role is a key influencer in enterprise innovation, regulatory alignment, and strategic decision-making. Serve as a key communicator and strategic advisor across executive, clinical, operational stakeholders and external stakeholders.

Requirements

Master’s degree in Health Economics, and/or degree in Mathematics / Statistics required
8+ years of experience in actuarial finance, network management, or healthcare analytics required
Proven leadership in an integrated delivery system
Strong understanding of healthcare reimbursement models and regulatory frameworks
Excellent communication and cross-functional collaboration skills
Experience influencing policy and driving enterprise innovation

Nice To Haves

Health plan government payer product management experience highly preferred

Responsibilities

Provide executive oversight for the design, implementation and management of a Medical Economics function at the health plan focused on total cost of care, provider / network performance, value-based care and Med Econ reporting
Lead research and forecasting on emerging medical trends, technologies, and cost-effectiveness to inform strategic planning to impact medical costs
Accountable to the PHP President, CMO and CFO to establish near term and long term PHP med econ priorities
Drive cross-functional strategy development to align member economics with PHS system-wide priorities and serve as an advisor to PHS delivery system leadership
Engage external stakeholders such as large employer groups, non-PHS providers and value-based care vendors in strategies to lower total cost of care
Partners directly with PHP Actuarial Finance, PHP Finance and PHS Enterprise Finance to support actuarial, finance and budgeting needs of the health plan and the enterprise
Collaborates with CMO, VP Population Health, VP Pharmacy, VP Provider Networks, and VP Claims Operations to identify and develop medical cost savings opportunities
Establish enterprise-wide benchmarks for provider unit cost and ensure contract compliance through strategic monitoring and analytics
Lead high-impact financial modeling and scenario analysis to inform contract negotiations and strategic approvals
Support payment accuracy initiatives, including claim edit reviews and savings validation, to ensure financial integrity
Support formulary impact assessments and collaborate with pharmacy leadership to optimize cost and clinical value
Guide advanced analytics on high-cost members and population risk profiles to inform care management and strategic interventions
Evaluate medical policy proposals through rigorous economic and clinical impact analysis prior to implementation
Monitor and report on ROI for clinical programs and strategic initiatives, ensuring alignment with enterprise goals
Develop and scale medical cost savings measurement in conjunction with PHP Transformation Offce.
Oversee enterprise deliverables including LODs, fee schedules, and regulatory documentation with strategic sign-off authority
Integrate regulatory and compliance analytics into operational and strategic frameworks