Medical Economics Advisor

Job title: Medical Economics Advisor

Company: Harris Health


Job description: Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:

• Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women

• Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR

• Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.

• Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.

Improving Members’ experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.Skills / Requirements

• JOB SUMMARY

The Medical Economics Advisor role will focus on analyzing healthcare cost trends, evaluating medical cost reduction program effectiveness, and providing data-driven insights to support strategic decision-making in value-based care initiatives. The Medical Economics Advisor will provide strategic recommendations to stakeholders by translating complex economic analyses into actionable insights to optimize financial performance and decision-making related to medical costs and utilization; essentially acting as a consultant who leverages data to guide healthcare organizations towards cost-effective practices.JOB SPECIFICATIONS AND CORE COMPETENCIES * Conduct and advise organization on complex analyses of medical cost trends, utilization patterns, and medical cost savings program effectiveness.

• Design and execute opportunity quantification and measurement strategies for medical cost affordability initiatives.
• Create and automate dashboards to track key performance indicators, to be maintained by junior members of the finance team or broader organization.
• Develop forecasting models to project future medical costs and program savings, and train junior members of the finance team or broader organization on running the models.
• Influence strategic decisions affecting medical cost management.

• Extract and analyze large datasets from various sources like claims, membership, and utilization data to identify patterns and trends in healthcare costs. Partner with clinical and
• business teams to identify opportunities for medical cost reduction or optimization.
• Drive millions in potential savings through program evaluation.
• Create clear and concise reports to communicate findings to leadership teams, highlighting key insights and actionable recommendations.
• Work closely with clinical teams, operations staff, and finance departments to identify areas for cost reduction and quality improvement.

• Lead recruiting, assessing, training, and mentoring of new and junior actuarial and analytical talent.
• Support network optimization and value-based contracting.
• Contribute to annual budgeting and forecasting processes while evaluating financial and clinical outcomes of value-based contracting arrangements.
• Evaluate financial and clinical outcomes of value-based contracting arrangements.

• Actively contributes to achievement of departmental goals, as identified in
• Departments annual business plan, including specific departmental process,
• improvement plans, and other duties as assigned.

Reports to Position Title: Actuarial DirectorQUALIFICATIONS: * Education/Specialized Training/Licensure: Bachelor’s degree in mathematics, Economics, Statistics, Engineering, or related field required.

• 2+ actuarial exams passed preferred

• Work Experience (Years and Area): 12 years of experience in a medical economics, health economics, healthcare analytics, or other related analytics function.

• 8 years of professional experience in a healthcare organization required.

• Management Experience (Years and Area): n/a

• Software Proficiencies: Excel, SQL Excel, MS SQL Server

Other: Required * Strong understanding of healthcare payment models and medical cost drivers.

• Experience with claims data analysis and risk adjustment methodologies
• Expertise in statistical analysis and research design
• Demonstrated Ability to translate complex analyses into actionable insights.
• Strong analytical and problem-solving abilities.
• Excellent project management skills.
• Clear written and verbal communication.
• Ability to work independently and in teams.
• Detail-oriented with strong quality control focus.
• Strategic thinking and business acumen.

Other: Preferred * Experience with value-based program evaluation.

• Background or experience with actuarial analysis.
• Strong understanding of healthcare payment models and medical cost drivers.
• Experience with claims data analysis and risk adjustment methodologies
• Expertise in statistical analysis and research design
• Demonstrated Ability to translate complex analyses into actionable insights.
• Strong analytical and problem-solving abilities.
• Excellent project management skills.
• Clear written and verbal communication.
• Ability to work independently and in teams.
• Detail-oriented with strong quality control focus.
• Strategic thinking and business acumen.

Application InstructionsPlease click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

Expected salary: $122000 – 156000 per year

Location: Houston, TX

Job date: Sat, 01 Mar 2025 08:03:42 GMT

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