Manager, Medical Economics

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
 
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

***This position is classified as hybrid and can be filled in one of the following CVS office locations. Hartford, CT., Woonsocket RI., Atlanta, GA., Irving, TX., Scottsdale, AZ., or Northbrook, IL. Additional CVS office locations may be considered at management discretion***

Position Summary

This fast-paced, high visibility, executive-focused analytical role will provide strategic assessments of emerging local market and national vendor relationships, deliver differentiated non-participating (Out-Of-Network) provider determinations, and evaluate changes to medical policy to support the overarching Medical Economic mission statement of reducing medical costs and medical costs trends to provide more affordable healthcare to Aetna and CVS Health members while improving quality and access.

As part of the Medical Economics National team, you will have the opportunity to present key trends, financial performance, tools and analyses with a broad MEU audience (including direct exposure to VP-level leadership). The MEU National team is accountable for working collaboratively across MEU to analyze, draw conclusions, and communicate the financial impact resulting from changes in Aetna’s clinical policies and vendor arrangements.

• Individual contributor that applies wide-ranging knowledge and experience of own job area within business unit or function, and may have advanced knowledge and practical experience of specific technical areas applied within the context of a similar industry or type of organization.
• Works collaboratively to analyze, draw conclusions, and communicate the financial impact resulting from changes in Aetna’s vendor arrangements, nonpar policies, and provider contracts.
• Set objectives and deliver results that have a significant impact within the context of a wider operational area.
• Plans and sets objectives to deliver responsibilities that have a direct effect on the business results within the context of the functional area that the job is in.
• Requires independent completion of work, where discretion is required within broader established operational boundaries of the function that job is in.
• Recognized as subject matter expert.
• Typically works independently and manages projects.
• Requires strong communication skills, creating an environment of teamwork and continual process improvement internal to MEU and external constituents.
• Provides Local Market support to Medical Expense Review teams on vendor, non-par and clinical topics.

Required Qualifications

Minimum 5 years experience and knowledge of:

Complex data collection, modeling & analysis.

Experience working with Excel, MS-Access and Web-based query tools.

Prioritizes & manages multiple projects while managing customer expectations and business priorities.

Work collaboratively and build relationships with colleagues.

Preferred Qualifications

Knowledge of:

• Extensive knowledge of managed care and how provider reimbursement policies relate to the control of medical claims costs.
• Full comprehension of provider contracts and the potential impact the regulatory/legislative environment has on reimbursement strategies.
• Understanding of internal and external database applications.
• Knowledge of market-place delivery (understanding of provider relationships).

Skill in:

• Advanced communication/presentation skills.
• Advanced software and programming skills.

Education

Bachelor’s Degree in business, finance, or related field OR equivalent work experience.

Pay Range

The typical pay range for this role is:

$66,330.00 - $145,860.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This