About the Role

The Director of Medical Economics will be responsible for a variety of exciting medical trend analytics at a fast-growing company. The person in this role will have the opportunity to provide insights into the company’s market and clinical leaders on medical expense drivers, clinical documentation, and clinical model performance. This role will be key in taking our medical expense reporting to the next level, providing actionable insights, and guiding the future state of analytics within the organization.

DUTIES AND RESPONSIBILITIES INCLUDE:

Medical Expense Reporting:

• Perform studies and reports related to medical costs, risk scores, revenue, and membership.
• Present strong visuals, tell compelling data stories and provide key insights to clinical and market leaders.
• Analyze results to identify early signs of adverse trends or other issues related to medical care costs and premium based revenue.
• Work in collaboration with IT and clinical teams to optimize performance analytics and medical economics.
• Help develop and enhance our analytic structure, including scalable reports and dashboards, supporting our financial performance from a cost perspective.

Performance Measurement:

• Perform analytics and reporting on existing and new clinical programs.
• Conduct studies on the value of existing and potential interventions and clinical programs – both to optimize our clinical models, as well as for use in marketing materials.
• Enhance predictive analytics and proprietary clinical algorithm to optimize outcomes.

Capabilities:

• Make the news, don’t just report the news. Find and reveal insights to bring to the table for leadership to drive conversation and clinical strategy.
• Apply a healthy balance of creative thinking and discipline in the development of core med expense processes and analytics.
• Identify overall drivers of emerging results and communicate clearly and succinctly to a non-technical audience.
• Develop and maintain strong working relationships with key stakeholders including market leadership, physician and clinical operations leadership, IT, the revenue optimization team, and finance peers.
• Ready to build new tools and capabilities in a new organization; show great initiative combined with the knowledge of when to ask for guidance.
• Manage several fast-paced projects with an ability to produce quality materials within tight timeframes.
• Integrate industry standards and external trend information to help ConcertoCare benchmark medical cost and utilization across markets and service categories.

QUALIFICATIONS

• Associate of the Society of Actuaries preferred but not required.
• Bachelor’s degree in actuarial studies, statistics, or related field preferred.
• Demonstrated experience with business intelligence reporting such as Microsoft Power BI, Tableau, or similar reporting tools.
• Minimum five years’ experience in the healthcare field with a strong understanding of health insurance. medical expense analysis, and medical coding.
• Experience in Government health care contracts preferred (Medicare and Medicaid)
• Proficient in Excel, Microsoft Office, SQL, SAS or other coding language

Base Salary/ Wage Range $130,000 to $145,000 plus annual bonus. Compensation for the role is commensurate with the candidate’s qualifications, skills, competencies, and experience and may fall outside of the range shown. ConcertoCare offers a competitive total rewards package, which includes full healthcare coverage, a 401K with match, and a broad range of other health, wellness, and financial benefits.

We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

ConcertoCare is an Alcohol/Drug/Smoke-Free Workplace