Highmark Health Medical Economics Consultant in Pittsburgh, Pennsylvania

Description

JOB SUMMARY

This job develops, coordinates and manages medical economics analysis, models, health outcome studies and related forecasting and actual results analysis related to the portfolio of activities that are focused on operating margin improvements, primarily focused on medical spend. This work will leverage market-leading health plan medical economics processes, tools and reporting. The incumbent serves as the key link between the Finance/Actuarial work in support of these initiatives and each business segment and functional area partners’ work, with focus on the coordination of infrastructure development to link initiatives with financial plans/forecasts, emerging results and pricing, infrastructure and process development to link medical economic related analytics (trend reporting, medical cost, conditions, etc.) with business partner actions, including progress and impact and functions as point person for all business segment medical economic analytics. Manages the matrix- specifically business partners and those support functions- who have accountability to implement initiatives in the portfolio. Reports into the Health Plan Finance Organization; however, significant emphasis will be placed on frequent and meaningful interactions with business segment and functional department executive/senior leadership to ensure that earnings improvement initiatives are identified and executed in a timely manner. The incumbent interacts 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 RESPONSIBILITIES

  • Coordinate the oversight and monitoring of the Health Plan “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 focus include 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 different initiatives.

  • 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 Market Segment 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 of the Health Plan 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.

  • Help develop and implement improved infrastructure and processes to provide Health Plan and Enterprise management with regular performance scorecards highlighting initiative implementation successes, accountability, “capture” of initiative benefits, activity, progress and identification of barriers.

  • Consistently work with Health Plan business and functional area partners to develop a pipeline of new initiatives, seeking to achieve our multi-year financial improvement targets. This effort focused on operating margin improvement is positioned to become a normal part of the way the Health Plan 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 a broad base of support to initiative owners in their efforts to identify potential operating margin improvement initiatives.

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

  • 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.

  • 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).

  • Determine when projections seem unreasonable and constructively push back until satisfied with the analysis.

  • Other duties as assigned or requested.

EDUCATION

Required

  • Bachelor’s degree

Preferred

  • Master’s degree

EXPERIENCE

Required

  • 5 years of progressive experience in Finance, Accounting or Analytics/Informatics with experience in Healthcare and a focus on medical economics

SKILLS

  • Medical economics

  • Financial analysis/modeling

  • Statistical/quantitative modeling

  • Executive communication

  • Direct report development/talent management

  • Collaboration across matrix organizational structure

REQNUMBER: J124966

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled