Manager, Medical Economics

CVS Health • Atlanta, GA

1d

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary This fast-paced, high visibility, executive-focused analytical role will evaluate changes to medical policy and their interactions with our network relationships to support the overarching Medical Economic mission statement of reducing medical costs and medical costs trends to provide more affordable healthcare to Aetna and CVS Health members while improving quality and access. As part of the Medical Economics National team, you will have the opportunity to present key trends, financial performance, tools and analyses with a broad MEU audience (including direct exposure to VP-level leadership). The MEU National team is accountable for working collaboratively across MEU to analyze, draw conclusions, and communicate the financial impact resulting from changes in Aetna’s network provider agreements. Individual contributor that applies wide-ranging knowledge and experience of own job area within business unit or function, and may have advanced knowledge and practical experience of specific technical areas applied within the context of a similar industry or type of organization. Serve as a subject‑matter expert for transplant Institutes of Excellence (IOE) initiatives, provider reimbursement validation, and medical economics rental network reporting Plans and sets objectives to deliver responsibilities that have a direct effect on the business results within the context of the functional area that the job is in. Typically works independently and manages projects. Own recurring and ad‑hoc reporting used by leadership, audit, and cross‑functional stakeholders Requires strong communication skills, creating an environment of teamwork and continual process improvement internal to MEU and external constituents. Provides Local Market support to Medical Expense Review teams on medical policy and provider topics

Requirements

• Bachelor's degree along with 3 - 5 years experience and knowledge of:
• Complex data collection, modeling & analysis.
• Experience working with Excel, MS-Access and Web-based query tools (SQL, BigQuery, etc.).
• Finance background
• Prioritizes & manages multiple projects while managing customer expectations and business priorities.
• Work collaboratively and build relationships with customers.

Nice To Haves

• Knowledge of: Extensive knowledge of managed care and how provider reimbursement policies relate to the control of medical claims costs.
• Full comprehension of provider contracts and the potential impact the regulatory/legislative environment has on reimbursement strategies.
• Understanding of internal and external database applications.
• Knowledge of market-place delivery (understanding of provider relationships).
• Skill in: Advanced communication/presentation skills.
• Advanced software and programming skills.

Responsibilities

• Evaluate changes to medical policy and their interactions with our network relationships
• Present key trends, financial performance, tools and analyses with a broad MEU audience
• Analyze, draw conclusions, and communicate the financial impact resulting from changes in Aetna’s network provider agreements
• Serve as a subject‑matter expert for transplant Institutes of Excellence (IOE) initiatives, provider reimbursement validation, and medical economics rental network reporting
• Plans and sets objectives to deliver responsibilities that have a direct effect on the business results
• Own recurring and ad‑hoc reporting used by leadership, audit, and cross‑functional stakeholders
• Creating an environment of teamwork and continual process improvement internal to MEU and external constituents
• Provides Local Market support to Medical Expense Review teams on medical policy and provider topics

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level