Director Medical Economics

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

Role Overview

Under the senior leadership of the Medical Economics group, the Director Medical Economics will provide strong leadership in the planning, development, and execution of reporting, information, and data policies, activities, and products that drive the achievement of strategic goals and business success for the Total Cost of Care Program.  This leader will enable innovative reporting, technology, and application solutions to support business needs.  They will provide actionable insight, to lead markets and the organization towards a best-in-class Total Cost of Care Model.  They will ensure that an appropriate medical economics discipline is incorporated into all reporting and analytics. Knowledge of Provider Reimbursement Methodologies is required.

Work Arrangement

• This is a 100% Remote position but you must live in EST or CST time zones

Responsibilities

• Lead team in development of Tools as we expand our Medical Economics playbook that lend to providing actionable insight to the organization with regards to Total Cost of Care
• Demonstrates excellent staffing capabilities through effective hiring, staff development and strong performance management
• Synthesize data that leads to collaborative discussions with various markets/departments with a goal of identifying actionable outcomes to improve a market’s Total Cost of Care
• Effectively present and communicate findings to various aspects of the business tailoring the communication to our business partners
• Engage with various groups of the business to create a cohesive/accountable structure for understanding business dynamics, potential areas for improvement and areas that have best- in-practice processes in place that can be used throughout the organization
• Ability to analyze Medical & Pharmacy utilization and cost trends
• Execute on root cause analysis and recommendation of corrective actions
• Identification of emerging issues using data analytics and tools
• Provide analytical support to drive execution of initiatives 
• Provide technical assistance as needed to aid staff development
   

Education and Experience

• Bachelor’s Degree in Actuarial Science, Economics, Computer Science, or a related field required; Masters preferred
• At least ten (10) or more years of  health plan analytics with in-depth analytics, technical expertise, and business knowledge; Actuarial, Analytics or Informatics experience preferred
• At least seven (7)+ years of experience in presenting analytic results
• At least seven (7) + years of experience in healthcare data analysis and information reporting. Facilitation, decision-making, organizational/business expertise, and analytical skills
• At least seven (7)+ years of experience with SQL and Tableau / Power BI  
• Proven experience managing teams and mentoring staff
• Strong project management, analytical and problem-solving skills, and the ability to work with and through people to achieve exceptional results
• Proficient in MS Office (Outlook, Word, Excel, PowerPoint, Teams) and SQL
   

Other Skills

• Strong team player with demonstrated ability to interact effectively with all levels
• Excellent verbal, written, and interpersonal skills; communication skills to facilitate conversations with internal and external parties
• Ability to thrive in a changing environment   
   

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.

Your career starts now. We’re looking for the next generation of healthcare leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well , and build healthy communities. As one of the nation's leaders in healthcare solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.