Medical Economics Manager
We have a current opportunity for a Medical Economics Manager on a permanent basis.
The Medical Economics Manager is responsible for analyzing healthcare cost trends, evaluating financial performance, and providing strategic insights to optimize medical expense management. This role involves working closely with actuarial, finance, and clinical teams to assess utilization patterns, negotiate provider contracts, and develop financial models to support business decisions.
Key Responsibilities:
- Analyze medical claims data to identify trends, cost drivers, and opportunities for financial improvement.
- Develop and maintain financial models to forecast healthcare costs, provider reimbursements, and risk adjustments.
- Collaborate with actuarial teams to evaluate population health metrics and risk adjustment factors.
- Assess the financial impact of provider contracts and reimbursement structures, ensuring cost-effective agreements.
- Partner with clinical and operational teams to identify strategies for reducing unnecessary healthcare spending while maintaining quality outcomes.
- Support the development of value-based care initiatives, including risk-sharing arrangements and pay-for-performance models.
- Prepare reports and presentations on medical expense trends, cost containment opportunities, and budget variances for senior leadership.
- Work with data analysts and IT teams to enhance data reporting capabilities and improve analytical tools.
- Stay up to date on healthcare industry regulations, reimbursement methodologies, and emerging cost containment strategies.
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