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Director, Medical Economics, Medical Expense Review

Primary Location: Plano, TX
Additional Locations: AZ-Phoenix, CT-Hartford, GA-Atlanta, IL-Chicago, PA-Blue Bell, PA-Cranberry, TX-Plano
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:
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.

Background Experience:
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.

Required Skills:
General Business - Communicating for Impact, Leadership - Creating a World Class Workforce, Leadership - Creating Accountability

Desired Skills:
General Business - Ensuring Project Discipline, General Business - Maximizing Work Practices, General Business - Turning Data into Information

Functional Skills:
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

Technology Experience:
Aetna Application - Enterprise Data Warehouse, Database - Microsoft Access, 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. Click here to review the benefits associated with this 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

Click To Review Our Benefits (PDF)


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