VP, Medical Economics

divh2Job Title/h2pProvides executive level strategy and leadership for team responsible for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities, and improve financial performance and outcomes. Collaborates with health plans to develop scoreable action item (SAI) tracking tools and identify opportunities to improve performance and data management, and support, guide and influence decision-making related to clinical programs, initiatives and strategy./ppstrongEssential Job Duties/strong/pulliRegularly unpacks detailed medical cost information to identify significant trends development and underlying causes of those trends./liliSupports executive strategy development, vision and direction for the enterprise medical economics function including SAI analytics, governance and trend mitigation. Demonstrates accountability for performance and financial results, and keeps executive leadership apprised./liliRecruits, hires, onboards, mentors, develops, and manages a team of medical economics team of professionals./liliCollaborates with senior level clinicians and leaders from functional areas such as finance, health care services and provider contracting to translate analytic observations into meaningful clinical/operational actions and management of clinical services to support, guide and influence decision making related to clinical programs, initiatives and strategy./liliLeveraging targeted analytics, works with business leaders to develop programs to support affordable, high quality health care delivery./liliIdentifies gaps in critical information and works with business leaders to develop solutions to capture or supplement information required./liliInforms and supports regular forecasting activities of the enterprise./liliPropagates best medical economics/analysis/SAI development practices across the enterprise./liliLeads enterprise information management (EIM) team to build out data analytic tools and capabilities./liliDevelops standards with regard to routine health care economics analyses, including types of analyses performed, frequency by health plan or line of business, etc./li/ulpstrongRequired Qualifications/strong/pulliAt least 12 years of health care analytics and/or medical economics experience, including 3 years of experience at an executive level, or equivalent combination of relevant education and experience./liliAt least 7 years management/leadership experience./liliBachelors degree in statistics, mathematics, economics, computer science, health care management or related field./liliExtensive experience in a leadership position in health care economics, preferably with complex organizations./liliAbility to effectively communicate and persuade technical and non-technical stakeholders, and engage with various levels within the organization./liliDemonstrated ability to work with sophisticated analytic tools and datasets./liliDemonstrated ability to convert observations into actions/interventions to improve financial performance./liliAdvanced understanding of Medicaid and Medicare programs or other health care plans./liliAdvanced analytical work experience within the health care industry (i.e., hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.)/liliAdvanced proficiency with retrieving specified information from data sources./liliAdvanced experience with building dashboards in Excel, Power BI, and/or Tableau and data management./liliAdvanced understanding health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.)/liliAdvanced understanding on health care financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form)./liliAdvanced understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRGs), Ambulatory Patient Groups (APGs), Ambulatory Payment Classifications (APCs), and other payment mechanisms./liliAdvanced understanding of value-based risk arrangements./liliAdvanced experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in health care./liliAdvanced problem-solving skills./liliStrong critical-thinking and attention to detail./liliExcellent verbal and written communication skills./liliProficient in Microsoft Office suite products, advanced skills in Excel (VLOOKUPs and pivot tables)/applicable software program(s) proficiency./li/ulpstrongPreferred Qualifications/strong/pulliExperience in complex managed care./liliAssociate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries (FSA)./li/ulpMolina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V./ppPay Range: $186,201.39 - $363,093 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level./p/div