Highmark Health Medical Economics Consultant - (Value Based Initiatives) in Pittsburgh, Pennsylvania

Description

General Overview:

The Medical Economics Consultant is responsible for the development, coordination and management of health care finance, models and actual results analysis related Value Based Initiatives. This work will leverage market-leading health plan financial planning processes, tools and reporting.

This position will manage Value Based initiatives with business partners and those support functions- who have accountability to implement initiatives in the portfolio. The position will report into the Financial Planning and Analytics department; however, significant emphasis will be placed on frequent and meaningful interactions with business segment and functional department executive/senior leadership to ensure that analytical models are created accurately and in a timely manner. As such, the position will interact with Health Plan Management (SVPs, VPs, Directors, etc.) in formal and informal situations, and must demonstrate a high-level of analytical, communications and influence skills.

Essential Job Functions:

  1. Coordinate the oversight and monitoring of the “Creating Customer Value” operating margin improvement effort, driving cross-functional team work efforts to identify, design, implement and monitor initiatives that improve the Organization’s revenue, claims and administrative expenses.
  • Use medical economics experience and knowledge to facilitate idea generation and quantification of savings initiatives (areas of focusinclude provider contracting, utilization management, care management, risk adjustment, operational efficiencies, product design, etc.).

  • Provide timely insight into claim cost drivers for the business segment leaders and identification of new improvement opportunities.

  • Understand the larger medical cost picture, and create process to identify and quantify interactions and dependencies of the differentinitiatives.

  1. Use medical economics experience and knowledge to develop and implement infrastructure to align and explicitly link initiatives’ savings estimates with the financial plans/forecasts, emerging financial results and product pricing.
  • Partner with Finance, Actuary, FP&A and the business and functional partner leaders to ensure that the initiatives are appropriately contemplated in current/future year projections and pricing models as well as monitored in the emerging financial results.

  • Coordinate savings opportunity projections and post implementation savings measurement with other areas.

  • Regularly interact with Senior Finance leadership, including the Chief Actuary and CFO, as well as other leadership and staff, to set and adjust overall goals and objectives of the process.

  • Provide greater ability to more timely engage, analyze, and implement beneficial but complex financial arrangements with new vendor business partners.

  1. Help develop and implement improved infrastructure and processes to provide management with regular performance scorecards highlighting initiative implementation successes, accountability, “capture” of initiative benefits, activity, progress and identification of barriers. Consistently work with the business and functional area partners to develop a pipeline of new initiatives, seeking to achieve our multi-year financial improvement targets. This effort focuses on operating margin improvement and is positioned to become a normal part of the way the organization does business, and will exist on-going every year. Train business partners in the use of business case return on investment measurement, developing a self-service culture that enables abroad base of support to initiative owners in their efforts to identify potential operating margin improvement initiatives.

  2. Develop improved business case and savings estimate capabilities to enable more accurate and deeper projections.

  3. Assist in the deployment of an employee-wide communications strategy, highlighting the operating margin improvement challenge and providing regular status reports with respect to achievement of targeted improvements.

  4. Lead in a matrixed work environment.

  • Influence other departments where you do not have direct authority.

  • Help drive a culture change from “reporting the past” to “creating the solutions for future."

  • Be persistent in following up with senior management and staff from numerous departments.

  • Collaborate with P&L owners and functional leaders. This will require strong communication skills (verbal and executive quality presentations).

  • Be able to determine when projections seem unreasonable and constructively push back until satisfied with the analysis.

  • Other duties as assigned or requested.

Minimum Qualifications:

  • Bachelor's Degree

  • 5 years of progressive experience in Finance, Accounting or Analytics/Informatics in the Healthcare payer sector with a focus on Medical Economics

Preferred Qualifications:

  • Financial analysis/modeling

  • Statistical/quantitative modeling

  • Relational database structure

Knowledge, Skills & Abilities:

  • Executive communication. Must be comfortable presenting findings and offering recommendations to Executive Leadership

  • Collaboration across matrix organizational structure

  • Detail oriented

Referral Award Payout Level: 2

REQNUMBER: J121417

Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity