Manager, Medical Economics
Seeking a Manager or Senior Manager of Medical Economics with deep expertise across Medicaid and or Medicare lines of business to lead trend analytics, enterprise reporting, and actionable insights that drive medical cost performance. This role sits at the intersection of analytics, finance, and clinical operations, partnering cross-functionally to identify cost drivers, translate data into scoreable action items, and influence enterprise strategy. The ideal candidate is equally comfortable building complex SQL queries, designing Power BI dashboards, and presenting findings to senior leadership.
Key Responsibilities
Medical Cost & Trend Analytics
- Lead medical cost trend analysis across Medicaid populations, identifying utilization, unit cost, mix, and population drivers.
- Develop and maintain PMPM, MLR, and unit cost reporting by service category, provider, network, and product.
- Conduct deep-dive analyses into emerging cost trends (inpatient, outpatient, professional, Rx, behavioral health) and translate findings into scoreable, actionable initiatives with measurable ROI.
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Enterprise Analytics & Reporting
- Build and scale enterprise-level analytics frameworks that provide a single source of truth across medical economics, finance, network, and clinical teams.
- Design, develop, and maintain Power BI dashboards and self-service reporting tools for executive and operational stakeholders.
- Own complex SQL development against claims, eligibility, authorization, provider, and clinical data sets.
- Drive standardization of KPIs, definitions, and methodologies across Medicare and Medicaid reporting.
Data Governance & Infrastructure
- Partner with Data Engineering and IT on data governance, data quality, and lineage, ensuring trusted inputs into medical economics reporting.
- Establish and enforce documentation, version control, and reproducibility standards for analytic deliverables.
- Influence enterprise data strategy - including warehouse design, data marts, and BI tooling - to support medical economics use cases.
Action & Influence
- Translate analytics into scoreable action items with clear owners, timelines, and savings/ROI targets; track initiatives through execution.
- Partner with Clinical, Network, Quality, Risk Adjustment, and STARs teams to surface intervention opportunities and measure impact.
- Present findings and recommendations to senior leadership, including the C-suite, with clear narratives and business implications.
- Mentor and develop junior analysts; at Senior Manager level, may have direct reports.
Qualifications
Required
- 5-10+ years of healthcare analytics / medical economics experience (Managing exp)
- Demonstrated expertise across Medicaid lines of business.
- Strong command of claims data (medical, Rx, eligibility, authorizations) and healthcare cost/utilization concepts.
- Advanced SQL skills against large-scale healthcare data warehouses.
- Hands-on Power BI development experience (DAX, data modeling, dashboard design); Tableau or similar BI tool experience also welcome.
- Experience leading trend analytics, MLR analysis, and cost-driver deep dives.
- Track record of producing scoreable action items that drive measurable medical cost savings.
- Bachelor's degree in a quantitative field (Economics, Statistics, Math, Public Health, Health Informatics, Actuarial Science, or related).
FAQs
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