Associate Director, Medical Economics - Remote
Company: Humana
Location: Louisville
Posted on: August 6, 2022
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Job Description:
**Description** The Associate Director, Medical Economics for
the Primary Care Organization within the Population Health Team is
responsible for working collaboratively with clinical, operational,
and financial leadership to identify and leading medical cost
saving initiatives that contribute to the success of Centerwell and
Conviva's financial performance.**Responsibilities** **About
Us**The Primary Care Organization (PCO), is looking for high
potential candidates who are looking to accelerate their career
development and contribute to driving disruption in the health care
industry. The PCO provides primary care medical group practice with
centers open or opening in Florida, Georgia, Kansas, Louisiana,
Missouri, Nevada, North Carolina, South Carolina and Texas. The PCO
has a strong emphasis on senior-focused primary care for members of
Medicare Advantage health plans and is committed to providing
personalized, high-quality primary care combined with an excellent
patient experience.At PCO we want to help those in the communities
we serve, including our associates, lead their best lives. We
support our associates in becoming happier, healthier, and more
productive in their professional and personal lives. We promote
lifelong well-being by giving our associate fresh perspective, new
insights, and exciting opportunities to grow their careers. Our
culture is focused on teamwork and providing a positive and
welcoming environment for all.We have over 215 clinics nationwide
and counting - come join us.**The Role** The Associate Director,
Medical Economics will work with regional clinical and operational
dyad partners to make data-driven strategy recommendations to bend
medical cost trends contributing to the financial success of the
organization. **Responsibilities** + Leads a team of cost and use
strategic advancement advisors.+ Partners with finance, business,
and clinical executive leaders to create benchmarks to monitor
medical cost trends and variances. Assists in the design and
evaluation of company KPIs to support long term goals.+ Supports
finance in the long-term planning process including development of
medical cost targets, key metrics, and projections.+ Builds strong
and trusting relationships with clinical and operation dyad leaders
at local and regional levels to support problem resolution and
ensure overall awareness of medical cost issues and challenges.+
Collaborate closely with the leadership of the primary care
organization data and application team to validate data, enhance
reports and tools, and help design new products for market
consumption.+ Prepares and analyzes cost, clinical, and operations
data to develop material presented to executive management.
Interpret results and articulate actionable recommendations that
maximize profitability and ensure trend bending targets are
achieved.+ Stays up to date of changing healthcare landscape to
maintain an awareness of CMS and Payor developments impacting
medical costs.+ Identify opportunities to measure and improve
business process effectiveness thru data-driven insights of cost
and utilization.+ Lead all trend bender initiatives, including
tracking deliverables, timelines, and holding stakeholders
accountable to drive targeted outcomes.+ Leverages data analytics
and modeling to test, validate and track return of investment of
existing and proposed medical cost strategies and
initiatives.**Vaccine Policy** Humana and its subsidiaries require
vaccinated associates who work outside of their home to submit
proof of vaccination, including COVID-19 boosters.Associates who
remain unvaccinated must either undergo weekly negative COVID
testing OR wear a mask at all times while in a Humana facility or
while working in the field. **Required Qualifications** +
Bachelor's degree in Finance, Data Analytics or Economics or
related field+ Previous management experience, supporting and
driving healthcare strategy+ A Minimum of five years of related
experience in data analysis role focusing on medical costs and/or
claims+ Minimum three years of experience managing strategic
projects and cross functional teams.+ Experience in a Medicare
Advantage, Hospital Systems and/or risk-based healthcare
organization+ Ability to analyze claims data to interpret cost and
utilization metrics that identifies Medicare Part A, B and D
opportunities among each specialty for actionable insights+ Proven
ability to synthesize and summarize complex and/or voluminous
content into clear, concise and actionable communications+
Experience effectively identifying, developing, and implementing
process improvements; to include 'outside of the box' solutions+
Excellent in building and cultivating relationships with key
business partners and stakeholders across organizational levels+
Ability to interpret the needs of the organization and communicate
actionable insights through analytics+ Excellent verbal,
interpersonal, and written communication skills+ Advanced Microsoft
Excel skills including statistical modeling, vlookup and pivot
tables**Preferred Qualifications** + Master's degree in Business or
related field+ Experience with PowerBI and SQL query writing+
Ability to model financial concepts of ROI, IRR, etc+ Extensive
knowledge of medical economics data such as hospital/physician /ASC
claims, utilization data, and healthcare industry coding systems
ICD-10, CPT/HCPCS, Revenue Codes, MS/APR-DRGs and APCs**Additional
Information** + This is a remote position; we are targeting
candidates who reside in: TX, GA, FL, or KY. These are preferred
locations.+
Keywords: Humana, Louisville , Associate Director, Medical Economics - Remote, Executive , Louisville, Kentucky
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