[Hiring] Medical Economics Lead Analyst @CVS Health

Role Description

We are seeking a remote analytical professional to join our Medical Economics - Medical Expense Review (MER) team. The primary goals of this team are to:

• Identify and communicate with leadership specific provider, procedure, and population level trends and outliers impacting the health plans medical cost trends.
• Analyze and size potential savings initiatives in coordination with clinical, finance, and network leads.

Qualifications

• 5+ years financial experience.
• 3-5 years’ experience with key managed care functions including provider and population analytics, provider contracting, benefit design, medical management as well as knowledge of business functions and impact on financials.
• Advanced skills in Excel and Web-based query tools to pull and analyze ad-hoc data.
• Critical skills within Excel include use of pivot tables to sort and organize data, use of formulas for financial modeling and data tagging, and creation of data visualizations to effectively communicate the trend story.
• Essential skill as reporting “super user” – able to easily navigate, comprehend, and tease out findings with a variety of enterprise reporting tools.
• 1+ years experience presenting to executive audience.
• Proven ability with critical thinking and expressing ideas clearly, concisely, and logically from a cross-functional perspective.
• Proven ability managing conflicting priorities and multiple projects concurrently. Demonstrates initiative, innovation, and leadership in achieving results.
• Ability to learn new technologies and analytic approaches.

Requirements

• Experience with Medicaid.
• SQL Coding: including the ability to run ad-hoc analyses to answer specific clinical or financial questions for the Account, Finance, UM, or Network Teams.
• Extensive knowledge of managed care and how provider reimbursement policies relate to the control of medical claims costs.
• Full comprehension of provider contracts and the potential impact the regulatory/legislative environment has on reimbursement strategies.
• An understanding of the healthcare industry.
• Underwriting, sales, product development, network management.

Benefits

• Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families.
• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.

Company Description

We’re building a world of health around every individual — shaping a more connected, convenient, and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable, and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family, and one community at a time.