Medical Economics Behavioral Health Lead Analyst

CVS Health•New York, CT

1d•$60,300 - $145,860•Remote

About The Position

We are seeking an analytical professional to join our Medical Economics - Medical Expense Review (MER) team. This individual will focus their time on developing savings analyses for Behavioral Health initiatives led by Medicaid Health Plans and Utilization Management Teams. The primary goals of this team are to a) identify and communicate with leadership specific provider, procedure and population level trends and outliers impacting the health plans medical cost trends, and b) analyze and size potential savings initiatives in coordination with clinical, finance, and network leads. Critical to the role will also be coordinating with BH and Analytics leads across multiple teams to obtain information on actions being taken to drive savings - which will be the key driver of building savings models to communicate results of the initiatives to leadership.

Requirements

Relevant analytical financial experience.
Minimum of 3-5 years’ experience with key managed care functions including provider and population analytics, provider contracting, benefit design, medical management as well as knowledge of business functions and impact on financials.
Advanced skills in Excel, and Web-based query tools to pull and analyze ad-hoc data.
Ability to build savings models based on a variety of utilization and cost metrics to size impact and monitor over time.
Critical skills within Excel include use of pivot tables to sort and organize data, use of formulas for financial modeling and data tagging, and creation of data visualizations to effectively communicate the trend story.
Essential skill as reporting “super user” – able to easily navigate, comprehend, and tease out findings with a variety of enterprise reporting tools.
Comfortable presenting to executive audience - with high skill level to build powerpoint visuals to explain trends as well as communication skills to articulate the key issues and actions efficiently.
Demonstrates critical thinking and expresses ideas clearly, concisely and logically from a cross functional perspective.
Ability to manage conflicting priorities and multiple projects concurrently.
Demonstrates initiative, innovation and leadership in achieving results.
Ability to learn new technologies and analytic approaches.
Bachelor’s Degree in business, finance, or related field OR equivalent experience.

Nice To Haves

Skills within SQL Coding that may be beneficial will include ability to run ad-hoc analyses to answer specific clinical or financial questions for the Account, Finance, UM, or Network Teams.
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.
An understanding of the healthcare industry is strongly preferred, including differentiating between inpatient and outpatient services, facility and professional claims, and impacts from population dynamics.
Underwriting, sales, product development, network management is also strongly preferred.
SQL Coding experience preferred but not required.

Responsibilities

Identify and communicate with leadership specific provider, procedure and population level trends and outliers impacting the health plans medical cost trends.
Analyze and size potential savings initiatives in coordination with clinical, finance, and network leads.
Coordinate with BH and Analytics leads across multiple teams to obtain information on actions being taken to drive savings.
Build savings models to communicate results of the initiatives to leadership.