Position Summary:

The Director of Medical Economics provides leadership in managing overall medical costs, regional medical cost action plans, and designs metrics for business partners that are accountable for implementation of action plans. Responsible for building expertise in provider contracting by leading the design, development, and distribution of database tools and applications to efficiently measure monitor, and/or forecast medical cost structure. Develops and presents actionable recommendations for utilization and unit cost management to business partners based on analysis. Partners with actuarial, underwriting, network, clinical and operations leaders to establish implementation strategy of action items.

Key Outcomes:

• Utilizes data and analytic information available to drive decisions, and evaluates impact, effectiveness, performance, and costs
• Provides leadership with quantitative analysis of healthcare cost and utilization data, identifying and implementing the appropriate analytic approaches and methodologies
• Partners with line of business leaders to develop and design medical economics analysis and outcomes reporting to be used for internal and external purposes
• Supports month end analysis, budget and forecast development, and medical expense projections
• Supports the development of medical expense management initiatives inclusive of cost saving projections and offsets in partnership with internal and external stakeholders
• Collects and refines appropriate data for analysis, provides summations, observations, and insights to address utilization trends and presents findings to management and other stakeholders (internal and external)
• Participates in strategic discussions regarding medical cost, utilization, contracting and care collaboration, and network programs
• Partners with leadership to develop analysis of provider cost and quality performance, identify opportunities for improvement, and propose changes to the reimbursement models, risk arrangements, etc.
• Leads medical expense work groups consisting of an interdisciplinary team of individuals from across the organization
• Actively measures and presents the effectiveness and return on investment of clinical programs
• Coordinates, manages, and tracks performance standards and reporting by developing effective tools that measure progress and the achievement of milestones
• Provides very complex programing and analytical support for medical cost trend analysis and strategic planning
• Creates population-based medical cost analyses from concept to completion
• Analyzes historical provider trends and experience to support the Company's strategic goals
• Interprets and communicates changes to regulatory requirements
• Trains team members on analytical tools and techniques