Medical Econ Manager

miami gardens, florida
 Primary Duties and Responsibilities
Provide independent analysis and insight to markets to constructively challenge their performance and support the annual life cycle of reporting requirements.
  • Serve as a market expert and consultant for medical trends, cost drivers and cost saving opportunities.
  • Responsible for monitoring profit and loss (P&L) for Medical Costs, and contributing to the market reaching the Medical Cost and Hospital Utilization finance plan and targets. Contribute as a market leader to success of whole market performance.
  • Lead projects focused on utilization management trends to help find insights in the data, and work with clinical, network and operational stakeholders to identify opportunities to improve and measure business process effectiveness.
  • Monitor data for care management and disease management, and work with local leadership and stakeholders to identify and provide strategies to execute improvement opportunities.
  • Coordinate with finance and market leadership a medical costs annual budget and help set yearly utilization targets.
  • Prepare and analyzes cost, clinical, and operations data to develop material presented to executive management.  
  • Track performance of KPI (Key Performance Indicators: financials/operational) for your market.
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  • Manage provider network costs, by ensuring appropriate coverage and minimizing extra payment costs.

Collaborate with market leadership to develop and implement new strategies and programs that improve overall market profitability

  • Leverage data analytics and medical cost modeling to provide insight into new and existing processes and business opportunities. Test and track efficiency of new multi-pronged strategies within the market.
  • Act as a data liaison for market leadership and stakeholders. Understand their needs and translate them into reporting and analytic solutions.
  • Build strong and trusting relationships with market leaders to support their problem solving and ensure overall awareness of issues and challenges in market. This will require some travel to the market and the ability to work effectively remotely with individuals.
  • Educate leadership, physicians and staff members how to effectively use reports and data resource tools.
  • Provide data analysis during pre-negotiation stages to support Market Network Directors with data on outside providers.
  • Collaborate with Market Directors and President to suggest new service lines such as collaborative psychiatric care and emergency paramedic home visiting based on medical unit costs, utilization and market best practices.medicalD

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