Medical Economics ManagerPrimary Location: Plano, TX
Additional Locations: CA-Concord, CT-Hartford, GA-Atlanta, NC-Cary, PA-Cranberry, TX-Plano Apply
We are seeking an analytical professional to join our Medical Economics - Medical Expense Review (MER) team. The primary goals of this team are to develop, interpret and favorably impact local market medical cost trend and provide analysis and network actions leading to medical cost improvement. This position will provide consultative support and medical cost based analysis of markets and network initiatives.
|Analyze and research medical costs drivers. Support the development of scoreable action items by identifying outlier cost issues. Consult with network and clinical management on opportunities to improve company’s discount position and strategic cost and utilization initiatives. Perform drill-down analysis to identify medical cost trend drivers; advise network of contracting opportunities to mitigate future trends. Own, track and document all aspects of related work from beginning to end of a project.|
|Applicants must have relevant analytical financial experience. An understanding of the healthcare industry is preferred. 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. Minimum of 1-3 years’ experience in the managed care industry with knowledge of provider contracting, provider reimbursement, patient management, product and benefits design. 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.|
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Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard. Required Skills: General Business - Applying Reasoned Judgment, General Business - Communicating for Impact, General Business - Turning Data into Information Desired Skills: Leadership - Collaborating for Results, Leadership - Driving Change Functional Skills: Information Management - Medical economics, Information Management - Medical Economics - segmentation and cluster analysis, Information Management - Utilizes and maintains pricing models and medical cost tracking tools Technology Experience: Desktop Tool - Microsoft Outlook, Desktop Tool - TE Microsoft Excel Potential Telework Position: No 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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