Director, Medical Cost Economics

Found in: beBee S US - 2 weeks ago

Work From Home, United States UPMC Senior Communities Full time
The Department of Health Economics is seeking a credentialed health actuary This position would drive high-visibility impactful analysis and would be responsible for developing and driving medical cost improvement strategies for UPMC Health Plan in collaboration with leadership. This includes analyzing medical cost utilization and unit cost data, identifying top trend drivers and affordability opportunities, developing strategies across cross-functional teams such as Clinical, Network, Finance, and Payment Integrity, supporting the execution of those strategies, and evaluating program and initiative outcomes.

The Director of Medical Cost Economics will manage one or more analysts and will require a diverse set of skills and experience, including data and analytics expertise, broad-based business and health economics acumen, a strategic mindset, and an ability to influence and leverage cross-functional teams in a non-traditional actuarial environment.

This is a work-from-home position located anywhere within the continental US with the expectation to travel to Pittsburgh (2-3 times a year) for meetings/conferences. Not only is UPMC Health Plan an industry leader, but this selected individual would be able to work closely with UPMC Enterprises and UPMC International, two other rock-star divisions of UPMC.

Responsibilities:
  • Partner with Health Plan senior leadership for creative problem-solving and strategic decision-making involving medical cost improvement strategies.
  • Lead the development of detailed actuarial and financial models that communicate near and long-term projections of financial performance of new and ongoing initiatives and clinical programs to facilitate corporate decision-making and the development of strategies and goals.
  • Forecast and interpret financial results, including variances from budget, to help identify medical cost improvement opportunities and potential risks.
  • Develop and gain support for data-based recommendations with team members from product, clinical, network, and strategy functions.
  • Bring clarity to complex problems using exceptional communication skills when engaging with senior leadership and technical audiences.
  • Apply an understanding of complex actuarial concepts, methods, and applications in a variety of situations.
  • Creatively leverage a wide range of datasets to inform key analyses.
  • Build strong relationships with Actuarial, Analytics, and Finance teams across the enterprise.
  • Ensure that departmental work products meet the highest standards of quality.


Qualifications:

  • Bachelor's degree in mathematics, statistics, actuarial science, economics, or related field required. Advanced degree preferred- FSA.
  • Experience in the following is a strong preference:
    • Value-based reimbursement, population health, segmentation/ stratification, claims development etc.
    • 8+ years of experience in progressively more responsible actuarial work in health insurance/managed care/consulting or equivalent education.
    • Experience with commercial and government health programs is preferred.
    • In-depth understanding of health insurance market dynamics.
    • Excellent problem-solving and analytical skills.
    • Excellent oral and written communication skills.
    • Adaptability and ability to prioritize effectively.
    • Strong PC skills.
    • Data retrieval skills and relational database experience.
    • Data visualization experience is preferred. Management experience preferred.

Licensure, Certifications, and Clearances:
  • ASA or FSA certification by Society of Actuaries required.
  • Membership in the American Academy of Actuaries is required.
  • Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran

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