Medical Economics Manager
Position Overview
Join my client to not only advance your career but also serve others in a meaningful way. As Manager of Medical Economics, you'll lead actuarial teams and projects to manage healthcare costs, improve Medical Loss Ratio (MLR), and develop innovative tools to support the mission. This is a prime opportunity to leverage your actuarial expertise in large-scale transformation projects and drive improvements in financial health while contributing to quality care.
Key Responsibilities
Lead Medical Economics projects to optimize healthcare costs and improve MLR, using data-driven strategies to reduce costs.
Develop processes and tools for financial and utilization monitoring, with a focus on managing MLR.
Collaborate with leadership on new operating models for Medical Economics, ensuring alignment with organizational goals.
Enhance and create tools in partnership with actuarial teams to support financial monitoring and decision-making.
Contribute to the Quality Program, including HEDIS and NCQA Accreditation, ensuring compliance and quality metrics are met.
Education & Requirements
8+ years of experience in healthcare related to actuarial services.
2 years of leadership experience in managing projects and people, with proven success in overseeing large-scale transformation projects.
At least 2 completed Actuarial Exams.
Experience working in a health plan or healthcare consulting environment.
Strong experience in Medical Loss Ratio (MLR) management and using Medical Economics to reduce MLR.
Expertise in leading and managing large-scale PMOs (Project Management Offices) for transformation projects, including measuring PMO performance.
Strong SQL programming experience required.
Experience with HEDIS reporting and metrics.
Key Qualifications
In-depth knowledge of actuarial principles and methods.
Proven ability to manage large-scale PMOs, from strategy to execution.
Strong analytical and problem-solving skills, with the ability to address complex issues in healthcare finance.
Excellent communication and project management skills, including presenting data to C-suite executives.
Detail-oriented, with a strong organizational ability and a track record of successful project outcomes.
FAQs
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