Director, Medical Economics - 66351BRPrimary Location: Hartford, CT
Additional Locations: AZ-Phoenix, CT-Hartford, IL-Chicago, PA-Philadelphia Apply
Provides oversight of all activities related to provider and/or facility contracting analytics to provide timely, accurate, actionable data and analysis for utilization and unit cost management in support of the organization’s strategic financial strategy. Provides analysis to senior management to support strategic and tactical operating decisions.
- Align with senior Medical Economics leaders to set organizational strategy.
- Responsible for building corporate expertise in provider and/or facility 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 High Performance Networks.
- 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.
- 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, provider reimbursement, 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.
- Medicare knowledge a plus.
- 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.
- Demonstrates initiative, innovation and leadership in achieving results.
- Bachelor's degree in Actuarial Science, Mathematics, Statistics, or other related field.
- Advanced degree preferred.
#LI-DI1 Potential Telework Position: Yes Percent of Travel Required: 10 - 25% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer Benefit Eligibility: Benefit eligibility may vary by position. Candidate Privacy Information: Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.
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