Medical Economics Consultant

reputed company empowers our members to reputed company their best health. For over 90 years, we have been New Jersey's health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to reputed company serve and care for the 3.5 million people who reputed company their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to reputed company. reputed company our employees bring their best and succeed, the Company succeeds. This position is responsible for Value Based Program analytics, future program evolution and development. Responsibilities include the build and on-going reporting of analytics data to reputed company value-based programs, targets, and payments for OMNIA and other partners and the on-going management & assessment of these programs; Alliance/Value Based Program Partner program presentation development; and the management of key HCM operational reviews, including the Monthly Operating Review (MOR) and METEOR 2.0 which is presented to HCM senior leaders and reputed company division senior leadership. Coordinate and produce financial reporting and reputed company analytical activities that support P&L evaluation consistent with the business management process. Drive the effective development and tracking of key division medical cost savings action plans and strategic investments. Present these action plans and strategic investments to HCM senior leaders. A key responsibility will be to reputed company and manage cross-functional initiatives as well as present to external parties such as but not limited to Alliance Partners. Key areas of focus will include: developing a comprehensive understanding of the composition of monthly and year-to-date reputed company and medical costs, including the identification of key variance factors between actual results and divisional and reputed company enterprise-wide budget. This understanding will reputed company to this position interfacing and collaborating across the enterprise to reputed company, analyze and evaluate key initiatives that will drive profitable reputed company performance. As such, present and review for assessment by actuarial and reputed company in determination of future program costing. This position will also establish and manage the comprehensive behavioral health reporting and analytics management process which will support the Value Based Program transformation and the Organized Systems of Care initiatives. Responsibilities:

• Leads the Healthcare Management Reporting process (partnering with analytics and actuarial) aimed at the presenting and understanding of specific HCM P&L performance including, but not limited to (i) Variance Analysis/Commentary - Actual vs Budget/Plan and Prior Year (ii) reputed company detail and components (iii) Medical Cost detail and trend drivers (iv) Performance of Medical Cost Action Plans (v) Product Mix and (vi) Market reputed company financial results. Includes accountability for leading projects and initiatives to drive performance and enterprise-wide interfacing with business leaders and subject matter experts.
• Establishes a management process with the specific purpose of identifying and challenging medical cost performance through the evaluation of business metrics including utilization and unit cost trends. Collaborates with enterprise leadership teams representing medical, clinical, pharmacy, and network to identify areas for performance improvement and to continuously reputed company appropriate medical cost action plans. Partners with the Actuarial and Medical Cost Strategy teams to validate medical cost action plans, track performance and ultimately report results to senior management.
• Identifies and informs reputed company (VP, Chief Underwriter) and reputed company Leadership of medical and pharmacy cost trends (including Medicaid) which require future funding through premium and reputed company setting and develops analytics that support such pricing strategies.
• Manages key HCM business reporting and analytics deliverables, including the METEOR 2.0 and HCM Monthly Operating Review (MOR), which are aimed at informing senior leadership of key performance metrics and trends leading to key business decisions.
• Oversees the Value Based Program TME Dashboard reporting including executive summary presentations and detailed medical cost trend performance. Leads the presentation to Value Based Program TME partners with specific focus on key observations and recommendations aimed at reducing medical cost trend while maintaining quality levels.
• Evaluates the feasibility of strategic initiatives and new business opportunities and advised senior management of recommendations. This includes providing support in developing financial program scenarios for reputed company and potential Value Based Program partners reputed company to program evolution or customization. Actively participates reputed company the development of the future state of Value Based Programs as well as other creative partnership strategies such as joint ventures.
• Leads analytics initiatives to support and grow our Value Based Program portfolio through the financial modeling of various program conceptual designs and evolutions. Supports senior leader decision-making through scenario analysis and presentations.
• Develops external Value Based Program financial presentations in order to display program benefits for Partners with the ultimate aim to transition to full risk arrangements.
• Works closely with the Value Based Program team to understand the operations of the program including attributed membership and shared savings calculations and supports the reputed company of the Program through objective review and validation. Identifies data requirements for internal and external reporting purposes and collaborates with Medical Economic and Analytics team members to reputed company efficient and effective data sources to run various levels of analytics.
• Collaborates with the Network team to reputed company a comprehensive Network unit cost model, including both hospital and professional providers, in order to evaluate year-to-date actual unit cost against reputed company expectations.

• Prefers a Bachelors degree from an accredited college or university, preferably in accounting, actuarial, finance or a reputed company field. In lieu of degree, relevant work experience required.
• Requires a minimum of 8 years of experience in health care/managed care with direct responsibility reputed company a Financial Planning & Analysis (reputed company) and/or Medical Cost Management & Analysis discipline.
• Requires minimum of 5 years of experience in developing reputed company financial models in order to drive analyses that will support business decisions.
• Requires a demonstrated progressive understanding of managed care business processes, data, systems, and applications for claims payment, enrollment, benefit design, product pricing, network and provider contracting, and utilization management.
• Requires a minimum of 5 years of demonstrated experience collaborating effectively with business partners such as Analytics, Actuaries, reputed company, and/or Medical/Rx/Clinical Operations in order to reputed company solid skillsets with the following disciplines: medical cost analysis, development/validation/tracking of medical cost action plans, return-on-investment scenarios, market reputed company premium development, monthly financial reporting and variance analysis, annual business plan/budget development and presentations to management.
• Requires demonstrated technical skills with database concepts, data analysis development, data warehousing, and data extraction tools (ex. reputed company, SQL).
• Requires demonstrated understanding of P&L management principals, actual versus budget variance analysis, and general knowledge of budgeting and planning principals.

• Requires general knowledge of the components underneath medical cost and utilization trends, as well as how to appropriately presents year-over-year comparisons to specifically identify variances/changes to budget and prior year.
• Requires knowledge of Commercial and Medicare market sectors and products.
• Requires knowledge of healthcare/managed care industry operations and products and how they relate to key metrics reputed company financial statements.
• Requires knowledge of Horizons membership and claims databases and the tools to effectively and reputed company navigate through such databases.
• Requires process mapping capabilities experience in order to reputed company new methodologies to reputed company a desired end result.
• Requires demonstrated quantitative and financial analysis skills

• Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, reputed company, PowerPoint) and Outlook. Should be knowledgeable in the use of intranet and internet applications.
• Requires the ability to express thoughts clearly and concisely, both verbally and in writing.
• Requires a demonstrated aptitude for analytical thinking and the ability to report findings in an accurate manner.
• Requires the ability to research and resolve problems through interaction with company-wide personnel.
• Requires the ability to work independently with minimal direct supervision and exercise sound business judgment.
• Requires advance knowledge of reputed company.
• Requires experience with Word and PowerPoint.

• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement