Medical Economics Consultant

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

The Medical Economics Consultant position reports to the Manager of Medical Economics and Business Processes. This position is primarily responsible for supporting the development of market trend analytics, enterprise-wide trends, executive decks, & enhanced metrics for our Total Cost of Care (TCOC) revenue & expense review process.   

Work Arrangement

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

Responsibilities

• Strong technical background and analytical insights 
• Strong business knowledge and the ability to work cross-functionally 
• Effectively communicate with leadership on market trends and areas of opportunity 
• Responsible for recurrent review of a given market/LOBs experience to generate a complete picture of medical/pharmacy expense and revenue trends
• Meet with other business teams on actionability from insights by helping develop High-Value Opportunities (HVOs) that provide savings/revenue added 
• Review and validate savings methodologies and estimates for ongoing initiatives
  
   

Education and Experience

• Bachelor’s Degree in Actuarial Science, Economics, Computer Science, IT, IS, or a related field strongly preferred OR equivalent combination of education and work experience will be considered
• One to three (1 – 3) years of experience working in Medical Informatics, Medical Economics, or related analytical positions at Managed Care Organizations, vendors, or providers
• Technology competencies include Azure Databricks, Python, MS SQL Server, Tableau, MS Power BI, Excel Data Models or equivalent technologies.
   

Other Skills

• Knowledge of Medicaid business and familiarity with healthcare domains (claims, UM, etc.)
• Knowledge of health informatics terminology & classification schemes (i.e., CPT codes, ICD-10 dx, common groupers like DRGs, CCS, etc.)
• Knowledge of industry-standard population health & quality KPIs (i.e., utilization per thousand, readmission rates, HEDIS metrics, etc.)
• Strong experience in SQL, Excel and Power BI
• Excellent communication skills
   

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.