job

The Medical Economics Director is responsible for the financial performance of the organization’s service delivery. The Director will analyze and interpret claims expense and reimbursement data to identify areas for improvement. The Director will work with operational departments to recommend cost initiatives that produce positive financial results and better member outcomes.

This position will allow the successful candidate to work a schedule that will be primarily remote and will report to Morrisville, NC as needed. There is no expectation of being in the office routinely. The successful candidates will be a resident of North Carolina or if currently residing out of state, able to relocate.

Responsibilities & Duties

Oversee service spending and reimbursement analysis and improvements. Oversee monitoring and analysis of service spending and reimbursement trends to identify opportunities for improving financial performance. Work with the CFO and SVP of Financial Operations to prepare and present regular financial reports to senior leadership, including forecasting future financial performance. Work with the SVP of Financial Operations to develop yearly service budget based on operational goals and strategic plan. Drive Medical Cost Action Plans and other Cost Initiatives. Use actuarial data to evaluate service performance and evaluate PMPM during rate setting. Monitor and forecast medical utilization patterns and flag outliers. Lead statistical analyses to assess effectiveness of clinical programs and initiatives in collaboration with the Chief Medical Officer (CMO) or designees. Coordinate with leadership to incorporate dashboards into business processes. Collaborate with Departments and Stakeholders on service delivery analytics, performance and cost.

Develop and maintain relationships with key stakeholders. Collaborate with other departments within the organization to ensure alignment of goals and objectives. Work with the Clinical and Network Operations to develop and implement strategies to improve the service delivery performance. Liaise with Clinical and Network Operations regarding financial implications of utilization and contract structures.
Liaise with IT to assist in enhancement of data warehouse BI analytics to include components that will assist in the evaluation of performance. Work with the Business Intelligence team to design, validate and deploy health economics dashboards to support cost reduction, quality of care improvement, patient/plan member satisfaction, and program tracking.

Othe responsibilities include:
– Manage and Develop staff.
– Oversee the Organization Performance Management Committee structure.
– Promote Innovation and Process Improvement
– Evaluate and monitor initiatives.

Minimum Requirements
Bachelor’s degree in Economics, Health Information Technology, Finance or a related field, and seven (7) years’ experience in managed care performing broad range of health plan data analytics, including three (3) years managing a team. Experience must include presenting to executive leadership; analysis of medical claims, clinical assessments, and EMRs; knowledge of health plan financial and regulatory reporting standards. Advanced knowledge of Medicaid Managed Care.

Salary Range
$75,438.27 to $129,865.03/Annually

Exact compensation will be determined based on the candidate’s education, experience, external market data and consideration of internal equity. An excellent fringe benefit package accompanies the salary, which includes:

Medical, Dental, Vision, Life, Long and Short-Term Disability
Generous retirement savings plan
Flexible work schedules including hybrid/remote options.
Paid time off including vacation, sick leave, holiday, management leave.
Dress flexibility

To learn more about this opportunity and to apply go to Alliance Health at https://www.alliancehealthplan.org/

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