Medical Economic Manager

Presbyterian is seeking a talented Medical Economic Manager.

This position will play a consultative role in helping to set the strategy and pricing and will be the financial expert within the product line. Position will work closely with pricing, clinical operations, provider network, provider contracting, and finance. Interpret, analyze, communicate and provide strategies related to the overall plan results of for a specific product line (i.e. Commercial, Medicare, Medicaid). Will include identifying medical and pharmacy cost trend drivers, including but not limited to, impacts from: clinical programs, contracting changes, provider network changes, geographical variation, medical cost initiatives and underlying population health. Identify opportunities for potential cost savings/revenue enhances/profitable growth opportunities.

This is a Full Time position - Exempt: Yes
• Rev Hugh Cooper Admin Center
• Work hours: Weekday Schedule Monday-Friday

Ideal Candidate:

A highly experienced medical economics analyst with strong analytical skills and the ability to synthesize data from multiple sources to evaluate health plan performance. This candidate excels at identifying emerging medical cost trends, recognizing patterns, drawing meaningful conclusions, and clearly communicating the financial impact and profitability of programs and strategies within a specific product line.

• Bachelors degree in healthcare, accounting, finance or other quantitative/related field.
• 6 years healthcare industry experience specifically medical economics/ interpreting/ analyzing product performance.
• Must have solid knowledge of most aspects of health plan operations and direct analytics experience working with most areas including but not limited to: medical management programs, population health programs, utilization management, care coordination, reimbursement methodologies, provider contracting including incentive strategies and value based reimbursement, claims payment, system configuration, sales/employer group reporting, premium development, finance and actuarial.
• Solid knowledge of healthcare industry and healthcare information standards such as ICD9/10, CPT codes, HCPCS codes, MS-DRG, ETGs, RBRVS, Utilization per K, PMPM, etc.
• Technical Skills: must possess strong technical skills in Microsoft Office Applications (Excel, Access, Word, PowerPoint) as well as experience using analytical/reporting applications such as Business Objects or other BI tools. Experience preparing Power Point presentations/ visualization of complex information in a simplified yet powerful manner.

• Acts as a consultant role in helping to set the strategy benefit design and pricing, as the financial expert within each product line.
• Proactively prioritize financial time-sensitive requests for information with finite resources.
• Present complex information in a compelling/articulate format/manner and will conduct ongoing performance and analytic reviews with a cross functional teams, including senior leadership and Medical Directors.
• Conduct research on health economic issues and trends and benchmarks. Educates internal and external customers on healthcare costs, utilization, and trends and how they relate to the effective management
• Reviews monthly reserve analysis (IBNR) and provides input regarding emerging trends, contract changes and other drivers of trend that could impact the monthly reserve analysis (IBNR).
• Responsible for setting and measuring product performance against budget and re-projection. Ensures that assumptions are consistent with membership and revenue assumptions.
• Provide some mentoring and training to others in departments as we as business partners as needed.

About Presbyterian Healthcare Services

Presbyterian offers a comprehensive benefits package to eligible employees, including medical, dental, vision, disability coverage, life insurance, and optional voluntary benefits.

The Employee Wellness Rewards Program encourages staff to engage in health-enhancing activities-like challenges, webinars, and screenings-with opportunities to earn gift cards and other incentives.

As a mission-driven organization, Presbyterian is deeply committed to improving community health across New Mexico through initiatives like growers' markets and local partnerships.

Founded in 1908, Presbyterian is a locally owned, not-for-profit healthcare system with nine hospitals, a statewide health plan, and a growing multi-specialty medical group. With nearly 14,000 employees, it is the largest private employer in the state, serving over 580,000 health plan members through Medicare Advantage, Medicaid, and Commercial plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.