In this individual contributor role as a Senior Medical Economics Manager, you will:
• Perform all aspects of value based contracting analytics in support of Aetna Medicaid health plans.
• Responsible for building corporate expertise in Medicaid health plan value based 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 Medicaid VBC.
• Manages the aggregate financial impact of contracts to support financial planning and management decisions.
• Builds corporate knowledge of all financial aspects of Medicaid health plan and VBC reimbursement methodologies and incentives.
• 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.
The typical pay range for this role is:
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
• 8 or more years experience in managed care contacting and/or analytics.
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.
• Ability to manage conflicting priorities and multiple projects concurrently.
• Excellent analytical and problem solving skills; familiarity with advanced financial and healthcare concepts.
• Strong organizational, management and leadership skills
• Excellent written and verbal communication and presentation skills.
• Knowledge of managed care and how provider reimbursement policies relate to the control of medical claims costs
• Prior experience in Medicaid managed care preferred
• Knowledge of Aetna data warehouse or QNXT preferred
• 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.
• Knowledge of market-place delivery (understanding of provider relationships)
• Advanced software and programming skills.
• Bachelor's Degree or equivalent work experience required
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.