Cost Containment Lead - 60747BRPrimary Location: New Albany, OH
Additional Locations: OH-New Albany Apply
- Monitors market level metrics and performance including utilization, clinical, site of care, financial, etc. to identify trends and mitigation strategies
- Partners closely with MEU on the MER process, as the local market POC, to provide local market insights and relativity data and ensures local market ownership / ideation / execution / accuracy of Scoreable Action Items (SAIs)
- Provides support, data, and insights to the Network and Operations officer and Network Managers to inform network strategy development
- Identifies and leads key cost containment initiatives at the local market level
- Educates local market colleagues on purpose and value of quality and cost metrics and assists in interpretation to solve problems and improve outcomes
- Supports key contract negotiations including identifying trend risks/opportunities and data deep dives contributing to med cost improvement opportunities
- Provides deep understanding of MER materials in advance of MER calls to maximize meeting productivity and decision making
- Owns initial SAI ideation on behalf of local market, with focus on Commercial and Medicare, including validation, preliminary analysis supporting hypothesis & directional scoring.; supports MEU in final scoring process.
- Develops strategy and tactics, and coordinates with enterprise partners to drive improvement in medical trend results
- Support VBC efforts by providing necessary and relevant data as necessary
#LI-HH1 Background Experience:
- Technical and analytics skills
- Deep knowledge of health care industry, policy, research design, statistical analyses, predictive modeling, case-mix and risk adjustment methods and tools
- Advanced technical, analytic and consultative skills, extensive knowledge of health care data and information systems, as well as an understanding of health care benefits, health care financing and health care delivery systems
- Ability to have provider / hospital facing conversations on performance improvement opportunities
- Ability to effectively communicate and negotiate across the business and in the external health care environment.
- Provides leadership in negotiation and influencing sound business decisions based on data, results and information derived from industry trends, research findings, and Aetna-specific reports and analyses
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