Medical Economics Manager
We have a current opportunity for a Medical Economics Manager. Out client is seeking a highly analytical and detail-oriented Medical Economics Manager to lead financial and actuarial analysis initiatives that drive strategic decision-making. This role focuses on medical cost trends, Risk Adjustment Factor (RAF) analysis, and actuarial modeling to support risk mitigation and financial sustainability. The ideal candidate has a strong background in healthcare finance, actuarial science, and RAF trends to optimize cost efficiencies and risk management strategies.
Key Responsibilities
- Conduct financial modeling, cost analysis, and actuarial assessments to evaluate healthcare utilization and provider performance.
- Analyze RAF risk scores and trends to assess population health risks and financial impacts on revenue.
- Develop and implement RAF optimization strategies, ensuring accurate risk score calculation and appropriate documentation.
- Monitor medical cost trends and utilization patterns, identifying key cost drivers and opportunities for improvement.
- Collaborate with actuarial teams to assess risk-sharing arrangements, capitation models, and value-based care strategies.
- Partner with finance, underwriting, and provider contracting teams to evaluate reimbursement structures and network efficiency.
- Conduct claims data analysis to support financial forecasting, risk adjustment, and cost containment strategies.
- Create dashboards, reports, and presentations to communicate findings and recommendations to leadership.
- Ensure compliance with CMS guidelines, risk adjustment methodologies, and actuarial best practices.
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