Medical Economics Senior ConsultantPrimary Location: Plano, Texas
Additional Locations: CA-Walnut Creek, 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 companys 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.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Functional - Information Management/Medical economics/4-6 Years
Functional - Information Management/Provides analysis and support for planning and forecasting of medical costs/4-6 Years
Functional - Information Management/Medical Economics - segmentation and cluster analysis/4-6 Years
Technical - Desktop Tools/TE Microsoft Excel/4-6 Years/End User
Technical - Database//4-6 Years/End User
Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User
General Business/Applying Reasoned Judgment/MASTERY
General Business/Communicating for Impact/ADVANCED
General Business/Demonstrating Business and Industry Acumen/ADVANCED
General Business/Maximizing Work Practices/ADVANCED
Leadership/Collaborating for Results/ADVANCED
Part-Time Telework (ex: 3 days office-based, 2 days telework), consideration only for locations near certain office location; training period in the office may be required
ADDITIONAL JOB INFORMATION
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
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.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna takes our candidates'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.
57070Potential Telework Position: Yes Percent of Travel Required: 0 - 10%
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