Medical Economics Consultant

Amerihealth Caritas•,

3d•Remote

About The Position

The Medical Economics Consultant reports to the Manager of Medical Economics and Business Processes. The role supports development of market and enterprise-wide trend analytics, executive presentations, and enhanced metrics for the Total Cost of Care (TCOC) revenue and expense review process. It is a 100% remote position, and the associate must reside in the Eastern or Central time zone. A reliable high-speed internet connection of at least 50 Mbps download and 5 Mbps upload is required.

Requirements

One to three years of experience in Medical Informatics, Medical Economics, or related analytical positions at managed care organizations, vendors, or providers.
Strong experience in SQL, Excel, and Power BI.
Strong technical and analytical capabilities, business knowledge, and ability to work cross-functionally.
Knowledge of Medicaid business and familiarity with healthcare domains such as claims and utilization management.
Knowledge of health informatics terminology and classification schemes, including CPT codes, ICD-10 diagnosis codes, and groupers such as DRGs and CCS.
Knowledge of industry-standard population health and quality KPIs, such as utilization per thousand, readmission rates, and HEDIS metrics.
Excellent communication skills.
For remote work, reside in the Eastern or Central time zone and have reliable high-speed internet with at least 50 Mbps download and 5 Mbps upload.

Nice To Haves

Bachelor’s degree in Actuarial Science, Economics, Computer Science, IT, IS, or a related field is strongly preferred; an equivalent combination of education and work experience will be considered.
Technology competencies in Azure Databricks, Python, MS SQL Server, Tableau, MS Power BI, Excel Data Models, or equivalent technologies.

Responsibilities

Support development of market trend analytics, enterprise-wide trends, executive decks, and enhanced metrics for the TCOC revenue and expense review process.
Conduct recurrent reviews of assigned market and lines-of-business experience to provide a complete view of medical and pharmacy expense and revenue trends.
Meet with other business teams to support actionability of insights, including developing High-Value Opportunities (HVOs) that add savings or revenue.
Review and validate savings methodologies and estimates for ongoing initiatives.
Communicate market trends and areas of opportunity to leadership.