Senior Manager Medical Economics
About The Position
The Senior Manager of Medical Economics is a critical leadership role responsible for analyzing medical costs, quality outcomes, and utilization drivers to support value-based primary care. The role plans, conducts, and leads analyses of healthcare claims data to identify root causes of trends and anomalies, translating complex datasets into actionable strategies for executive and field leadership. The Senior Manager serves as a strategic partner to clinical and financial stakeholders, using data-driven insights to optimize cost management and operational performance. The role develops financial models and forecasts related to healthcare costs and utilization, projects future expenditures, estimates potential savings, evaluates the financial impact of clinical initiatives, and assesses the clinical and financial return on investment of value-based care initiatives. It also designs and maintains reports and dashboards, collaborates with Finance, Clinical, and Data Science teams on cost-saving opportunities and value-based payment models, partners with Data Engineering on scalable analytics infrastructure, and ensures analyses and reporting comply with regulatory requirements and industry standards.
Requirements
- At least 7 years of experience in quantitative analysis, healthcare analytics, or medical economics within the healthcare or payer industry.
- Deep subject matter expertise in value-based care, population health, and medical claims data, including ICD-10 and CPT.
- Advanced proficiency in SQL for complex data extraction, manipulation, and analysis.
- Proven track record of leading cross-functional teams and presenting executive-ready insights to C-suite and clinical leadership.
- Exceptional problem-solving, decision-making, and project execution skills.
- Bachelor’s degree in a STEM field, finance, economics, or a related analytical discipline.
Nice To Haves
- Advanced degree preferred.
- Proficiency with business intelligence tools such as Tableau or Power BI.
- Experience in value-based care analytics for Medicare Advantage and Traditional Medicare programs, such as ACO REACH and MSSP.
Responsibilities
- Develop financial models and forecasts related to healthcare costs and utilization for executive review and strategic planning.
- Project future healthcare expenditures, estimate potential savings, and evaluate the financial impact of clinical initiatives and interventions.
- Design and maintain reports and dashboards to monitor key performance metrics and economic drivers.
- Collaborate with Finance, Clinical, and Data Science teams to identify cost-saving opportunities and optimize value-based payment models.
- Evaluate the effectiveness of value-based care initiatives on medical cost and quality outcomes and assess clinical and financial return on investment.
- Partner with Data Engineering to develop long-term data assets and infrastructure that enable scalable advanced analytics.
- Ensure analyses and reporting adhere to regulatory requirements and industry standards for medical economics.
- Lead analyses of healthcare claims data to identify root causes of trends and anomalies, and communicate actionable insights to executive and field leadership.
Benefits
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources to support colleagues’ physical, emotional, and financial well-being, based on eligibility
- Eligible for a CVS Health bonus, commission, or short-term incentive program
- Equity award program
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What This Job Offers
Job Type
Full-time
Career Level
Senior
