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Medical Economics Consultant - Rx

Primary Location: Phoenix, AZ
Additional Locations: AZ-Phoenix
Retrieves, organizes and performs analysis on data, is actively involved in decision making process to provide results against plan objectives.

Fundamental Components:
Analyzes more complex types of capitated and fee-for-service provider contracts and presents results against budgets and benchmarks, performs variance analysis. Produces more complex ad hoc reports to satisfy information needs across products/segments and markets. Develops provider compensation and fee schedules . Provides consultative support to network managers with legitimacy testing of rate proposals. Utilizes, maintains and develops pricing models and medical cost tracking tools. Provides more complex and detailed analysis and support for planning and forecasting of medical costs including the development of gross medical trend estimates. Supports the development of scoreable action items by identifying outlier cost issues, providing ad hoc analysis and generating ideas for moderation of trend increases. Identifies overpayments and prepares projects for recovery. Determines strategy presentation of hospital chargemaster reports to implement rate adjustments. Works cross-functionally within the region and supports achievement of regional operating plan targets. Provides network cost support to sales and marketing in the "Request for Proposal" process.

Background Experience:
Demonstrates understanding of key pharmacy concepts, such as pricing methodology, utilization management, PDL, and Specialty pharmacy. Demonstrates initiative, innovation and leadership in achieving results. Demonstrates critical thinking and expresses ideas clearly, concisely and logically from a cross functional perspective. Advanced skills in Excel and SQL query tools. Ability to learn new technologies. Minimum of 2-5 years’ experience in the PBM or managed care industry with knowledge of provider contracting, provider reimbursement, patient management, product and benefits design. Strong analytical ability and familiarity with advanced financial and healthcare concepts. Ability to manage conflicting priorities and multiple projects concurrently. Bachelor's Degree in Business, Finance, Mathematics or related field preferred or equivalent work experience in the healthcare industry.

Additional Job Information:
This position will be primarily focused on pharmacy analysis, identifying trend drivers and pharmacy savings opportunities as well as downstream medical cost impacts. The position will offer regular opportunities to communicate with Medicaid Pharmacy leadership, health plan Pharmacy Directors, and other health plan leadership.

Required Skills:
General Business - Communicating for Impact, General Business - Consulting for Solutions, General Business - Turning Data into Information

Desired Skills:
Finance - Delivering Profit and Performance, General Business - Applying Reasoned Judgment

Functional Skills:
General Management - Data analysis & interpretation, General Management - Data tools: building & utilization, Information Management - Medical economics

Technology Experience:
Database - Microsoft SQL Server, Desktop Tool - TE Microsoft Excel

Potential Telework Position:

Percent of Travel Required:
0 - 10%

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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