Medical Economics Manager
We are seeking a strategic and analytical Medical Economics Manager to lead initiatives focused on quality analytics, HEDIS performance, value-based care (VBC), and managed care optimization. This role plays a critical part in driving data-informed decisions that improve healthcare outcomes, enhance provider performance, and support payer-provider alignment.
Key Responsibilities:
Quality Analytics & HEDIS:
- Lead the development and execution of analytics strategies to monitor and improve HEDIS measures.
- Collaborate with clinical and operational teams to identify gaps in care and implement targeted interventions.
- Analyze trends in quality performance and generate actionable insights to support NCQA accreditation and regulatory compliance.
- Develop dashboards and reports to track quality metrics and communicate findings to stakeholders.
Value-Based Care (VBC):
- Support the design and evaluation of VBC programs, including shared savings, pay-for-performance, and risk-based contracts.
- Conduct financial modeling and impact analysis of VBC arrangements.
- Partner with provider networks to assess performance and identify opportunities for improvement.
- Monitor key performance indicators (KPIs) related to cost, utilization, and quality under VBC contracts.
Managed Care Strategy:
- Analyze claims, encounter, and eligibility data to evaluate managed care performance.
- Provide insights to support contract negotiations, network development, and utilization management.
- Collaborate with health plans and internal teams to align incentives and improve member outcomes.
- Ensure compliance with CMS, state Medicaid, and commercial payer requirements.
Qualifications:
- Bachelor's degree in Health Economics, Public Health, Statistics, Business, or related field (Master's preferred).
- 5+ years of experience in healthcare analytics, medical economics, or managed care.
- Strong knowledge of HEDIS measures, NCQA standards, and VBC models.
- Proficiency in SQL, SAS, R, Python, or other data analysis tools.
- Experience with healthcare data sources (claims, EMR, eligibility, etc.).
- Excellent communication and presentation skills.
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