Manager, Medical Economics

Overview

What you can expect! 

 

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

 

The Manager of Medical Economics is responsible for driving Medical Economics projects to aid IEHP in managing healthcare costs and improve Medical Loss Ratio (MLR). This position will lead teams of actuarial professionals on project initiatives in addition to direct reports. Responsibilities will include:

• Stand-up processes and analytical tools that monitor financial and utilization metrics in claims experience to support the financial health of IEHP,
• Work with leadership to develop new operating model for Medical Economics,
• Partner with other actuaries to leverage existing tools, and
• Create new tools and enhance current tools.

 

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Additional Benefits

Perks

 

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

• Competitive salary.
• Hybrid schedule.
• CalPERS retirement.
• State of the art fitness center on-site.
• Medical Insurance with Dental and Vision.
• Life, short-term, and long-term disability options
• Career advancement opportunities and professional development.
• Wellness programs that promote a healthy work-life balance.
• Flexible Spending Account – Health Care/Childcare
• CalPERS retirement
• 457(b) option with a contribution match
• Paid life insurance for employees
• Pet care insurance

Key Responsibilities

Work with Actuarial leadership and Chief Financial Officer to develop a 2025 and beyond Operating Model for Medical Economics. Socialize new Operations Model to broader IEHP including Chief Executives. Coordinate cross-functionally to ensure stakeholder feedback is incorporated throughout the year to address ongoing Med Econ needs of business units.

Serve as one of the key Subject Matter Experts (SMEs) for Medical Economics projects to senior leadership across IEHP to help coordinate projects, coordinate needs, and ensure ongoing alignment with broader organization.

Act as a one of the key architects to design and build analytical tools that drive early insight and trend monitoring on key cost MLR drivers across all lines of business. Partner with existing Actuarial SMEs to increase our speed-to-market in various analytical capabilities.

Develop relationships with key decision-making leaders across IEHP to help influence change that will bend the MLR cost curve.

Develop processes to ensure ongoing monthly monitoring of cost trends. Develop templatized approach that can be scaled across numerous medical economics cost driver analyses.

Evaluate the effectiveness of current cost management practices and recommend improvements.

Integrate cost management and value-base care efforts with quality improvement initiatives by identifying synergy opportunities between Actuarial and Quality Department to align financial incentives with quality outcomes.

Navigate ambiguity; create an organized and structured approach to ambiguous projects.

Analyze healthcare cost data to identify trends, patterns, and areas for cost reduction.

Conduct complex claims analyses utilizing IEHP Enterprise Data Warehouse

Hire, train, and manage support staff, while monitoring and evaluating outcomes. Conduct performance reviews of each Team Member within IEHP guidelines.

Provide training and guidance to other associates within IEHP.

Perform any other duties as required to ensure Health Plan operations and department business needs are successful.

Supervises work of others, including planning, assigning, scheduling and reviewing work, ensuring quality standards. Is responsible for hiring, terminating, training and developing, reviewing performance and administering corrective action for staff. Plans organizational structure and job content.

Qualifications

Education & Requirements 

• Eight (8) years of health care experience relevant to actuarial services
• Two (2) years of leadership experience in managing projects and people is required
• Experience in other health plans or healthcare consulting required
• Bachelor’s degree from an accredited institution required
• Two (2) Actuarial Exams completed/passed required