Director of Medical Economics

Summary:

Responsible for leading a team which conducts analyses of medical cost data for Medicare populations with the goal of identifying opportunities to reduce costs and improve patient health and experience. Extracts, analyzes, and synthesizes data from various sources to identify risks and opportunities. Builds and leverages cross-functional relationships to develop best practices. Supports the creation of reports and presentations for executive level audience.

Essential Duties and Responsibilities:

• Build and leverage cross-functional relationships to collaborate ideas, information, cases, and industry analyses to develop best practices.
• Develop and execute Genuine’s affordability agenda, while assisting with ongoing reporting and monitoring of related cost-savings drivers
• Synthesize large data sets into succinct, actionable presentations. Interpret information clearly and accurately to concisely communicate results and recommendations to stakeholders, executive management, etc.
• Manage projects with external vendors to gather and review evidence development builds (retrospective claims analysis, health economic models, etc.)
• Develop and oversee the creation of value-based resources (i.e., value-based summaries, calculators, etc) and clinical-economic evidence.
• Thinks critically about the accuracy, interpretation and implications of data to anticipate change, analyze potential access and reimbursement issues and opportunities in the healthcare landscape
• Lead teams in data collection, management, analysis and reporting across a variety of data platforms including Excel, Power BI, analytical cubes, and SQL.
• Write SQL queries, create end-user reports, and apply varying analytical techniques to solve specific business problems.
• Understand and analyze medical claims, including spend and utilization by place of service, procedure, and diagnoses, and other data sources to identify early signs of trends in medical costs.
• Structure analytical results in an organized, visual manner to tell a meaningful, actionable story.
• Display and interpret data using visualization tools.
• Ensure confidentiality and professionalism is maintained when dealing with sensitive information.
• Performs other duties as required.

Supervisory Responsibilities:

• Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws.
• Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

Knowledge, Skills and Abilities

• Excellent leadership, management, and project management skills.
• Ability to effectively liaise between finance, technical and non-technical teams.
• Experience in data mining, statistical analysis, and data transformation /manipulation
• Demonstrated ability to analyze data and apply investigative skills in resolving issues.
• Demonstrated ability to work on multiple projects simultaneously with minimal supervision.
• Demonstrated ability to produce clear, written progress notes and supporting documentation.
• Highly self-motivated and directed with keen attention to detail.

Minimum Education and Experience

• Bachelor’s degree in STEM field, Statistics, Economics, Finance or related field
• 10 years of healthcare experience working with medical claims, membership, and provider data
• 5 years of Management/Leadership experience
• Experience with Structured Query Language (SQL) – creating queries, performing data manipulations and analysis
• Advanced proficiency with Excel using PivotTables, linked worksheets, graphing and other reporting and presentation features
• Experience with data visualization tools (Power BI)
• Strong verbal and written communication skills.
• Strong analytical and problem-solving skills.

Note: Nothing in this job specification restricts management’s right to assign or reassign duties and responsibilities to this job at any time. Critical features of this job are described under various headings above. They may be subject to change at any time due to reasonable accommodation or other reasons. The above statements are strictly intended to describe the general nature and level of the work being performed. They are not intended to be construed as a complete list of all responsibilities, duties, and skills required of employees in this position.