Medical Economics Manager
Position Overview
We are seeking a Medical Economics Manager to join a growing healthcare analytics organization focused on improving cost, quality, and clinical outcomes across value-based populations. This individual will lead medical cost and utilization analyses, identify key drivers of financial performance, and translate complex healthcare data into actionable recommendations for clinical, operational, and executive stakeholders.
The ideal candidate combines strong healthcare claims analytics experience with an understanding of Medicare, value-based care, and provider performance.
Key Responsibilities
- Lead medical cost, utilization, and trend analyses across Medicare and other healthcare populations.
- Analyze medical and pharmacy claims to identify cost drivers, utilization patterns, and opportunities for improved performance.
- Monitor key metrics including PMPM cost, inpatient admissions, ER utilization, readmissions, length of stay, specialist utilization, and site-of-service trends.
- Develop financial models and forecasts to evaluate medical expense trends and population performance.
- Partner with clinical, finance, network, and operational teams to develop strategies that improve cost and quality outcomes.
- Evaluate provider and market performance through benchmarking, variance analysis, and trend reporting.
- Support value-based arrangements through analysis of risk, utilization, quality, and financial performance.
- Build dashboards and executive-level reporting that clearly communicates findings and recommended actions.
- Lead complex analytical projects from initial business question through analysis, presentation, and implementation.
- Mentor and provide analytical guidance to junior team members while helping establish best practices across the medical economics function.
Qualifications
- 5+ years of experience in medical economics, healthcare analytics, healthcare finance, actuarial analytics, or cost-of-care analytics.
- Strong experience analyzing healthcare claims, membership, provider, and utilization data.
- Experience within Medicare Advantage and/or value-based care strongly preferred.
- Strong understanding of medical cost drivers, healthcare utilization, reimbursement, and provider performance.
- Experience with SQL and advanced Excel required; Power BI, Tableau, SAS, Python, or similar analytics tools preferred.
- Ability to translate complex analyses into concise recommendations for senior leadership and non-technical stakeholders.
- Experience working cross-functionally with teams such as Finance, Clinical Operations, Network Management, Population Health, or Actuarial.
- Prior leadership, mentoring, or project management experience preferred.
- Bachelor's degree in healthcare analytics, economics, finance, statistics, mathematics, public health, or a related quantitative field.
FAQs
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