Medical Economics Consultant Senior

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 Senior reports to the Manager of Medical Economics & Business Process. This position is primarily responsible for leading 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

• 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 and coordinate 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
• Strong technical background & analytical insights
• Strong business knowledge and the ability to work cross-functionally 

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
• At least five to ten (5 – 10) years of related experience with at least three (3) years 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

• Strong knowledge of Medicaid business and familiarity with healthcare domains (claims, UM, etc.)
• Strong knowledge of health informatics terminology & classification schemes (i.e., CPT codes, ICD-10 dx, common groupers like DRGs, CCS, etc.)
• Strong 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
   

Our Comprehensive Benefits Package

Flexible work solutions include 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.