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Job Details


CVS Health

Senior Medical Economics Manager (2090656BR)

Pharmaceuticals

All

Yearly

No

Hartford, Connecticut, United States

Job Description
In this individual contributor role as a Senior Medical Economics Manager, you will:

• Responsible for building corporate expertise in provider and/or facility contracting by leading the design, development, and distribution of database tools and applications to efficiently measure, monitor, and/or forecast medical cost structure.
• Develops and presents actionable recommendations to management based on analysis.
• Builds best practices and provides analytical support to regions supporting High Performance Networks.
• Manages the aggregate financial impact of contracts to support financial planning and management decisions. Collaborates with Medical Management on cost saving opportunities.
• Builds corporate knowledge of all financial aspects of government program reimbursement methodologies and prevalent Coventry reimbursement methodologies.
• Works with Operations to ensure financial integrity is achieved and maintained from the provider contract to the actual claim adjudication.
• Participates in research-related activities including industry best practices and experience studies.
• Provides input into the department budget. Controls expenses while meeting service requirements.
• Performs other duties as required.

Required Qualifications
7 or more years experience in managed care contacting and/or analysis and/or healthcare.

COVID Requirements


COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

Preferred Qualifications
• 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.
• Advanced communication/presentation skills.
• Understanding of internal and external database applications.
• Knowledge of market-place delivery (understanding of provider relationships.
• Advanced software and programming skills.
• Excellent analytical and problem solving skills
• Strong organizational, management and leadership skills
• Excellent written and verbal communication and presentation skills.

Education
Bachelor's degree or equivalent work experience

Business Overview
Bring your heart to CVS Health
Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.