Medical Economics (Medical Expense Review) Manager

CVS Health • Hartford, OK

8d

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 It’s an exciting time for our Medical Economics team at CVS Health. As a growing team in a Fortune 5 company, we can provide amazing benefits to our employees along with continuous career development. This includes flexible work location, a great work-life balance, and a competitive salary. You will also be able to flex your analytics and consultative skills to positively impact our patients’ health. As a Medical Economics Manager, you will provide consultative support and medical cost-based analysis of markets and network initiatives. You will be responsible for consulting with network and clinical management on opportunities to improve our company’s discount position and strategic cost and utilization initiatives and is essential to managing conflicting priorities and multiple projects. As part of the Medical Expense Review (MER) team, you will prepare for monthly presentations, and manage both long and short-term projects, working collaboratively with local market leaders to accomplish tasks and goals that will improve the care we give our patients. You will also:

Requirements

• 5+ years of experience in analytics or finance equivalent experience.

Nice To Haves

• 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).
• Advanced communication/presentation skills.
• Advanced software and programming skills

Responsibilities

• Perform complex analytical projects to research utilization and unit cost medical cost drivers.
• Turn data into usable information by telling the story through data visualization
• Support the development of scoreable action items by identifying outlier cost issues
• Lead discussions and presentations with the local market plan leadership and within Medical Economics about medical cost drivers and mitigating cost opportunities.
• Be accountable for tracking and documenting all aspects of related work from beginning to end of a project.
• Work with Excel, MS-Access, Power BI, and Web-based query tools (data warehouse)

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: Manager