Aetna Director, Medical Economics, Medical Expense Review in Concord, California
Req ID: 69933BR
Provides oversight and leadership of all activities related to Medical Economics - Medical Expense Review (MER) team. The primary goal of this team is to provide timely, accurate, actionable data and analysis for utilization and unit cost management in support of the organization s strategic financial strategy.
Fundamental Components included but are not limited to:
Align with senior Medical Economics leaders to set organizational strategy.
Develops and presents actionable recommendations to management based on analysis.
Manages the aggregate financial impact of contracts to support financial planning and management decisions.
Collaborates with Medical Management on cost saving opportunities.
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.
Qualifications Requirements and Preferences:
8+ years experience in managed care contracting and/or analytics. Applicants must have relevant analytical financial experience. An understanding of the healthcare industry is required. Familiarity with key managed care functions including provider contracting, benefit design, medical management as well as knowledge of business functions and impact on financials (underwriting, sales, product development, network management) is also strongly preferred.
Advanced skills in Excel, MS-Access and Web-based query tools (MCM, data warehouse). Ability to learn new technologies. SAS Enterprise Guide experience preferred. Strong analytical ability and familiarity with advanced financial and healthcare concepts. Demonstrates critical thinking and expresses ideas clearly, concisely and logically from a cross functional perspective. Ability to manage conflicting priorities and multiple projects concurrently. Demonstrates initiative, innovation and leadership in achieving results.
Bachelor's degree in Actuarial Science, Mathematics, Statistics, or other related field. Advanced degree preferred.
Information Management - Medical economics, Information Management - Provides analysis and support for planning and forecasting of medical costs, Information Management - Provides very complex programming and analytical support for medical cost trend analysis and strategic planning, Management - Management - Data analysis and interpretation
Aetna Application - Enterprise Data Warehouse, Database - Microsoft Access, Desktop Tool - TE Microsoft Excel
General Business - Communicating for Impact, Leadership - Creating a World Class Workforce, Leadership - Creating Accountability
General Business - Ensuring Project Discipline, General Business - Maximizing Work Practices, General Business - Turning Data into Information
Benefit eligibility may vary by position.
Job Function: Healthcare
Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.