Manager Medical Economics - Actuary
Company: Presbyterian Healthcare Services
Location: Albuquerque
Posted on: May 14, 2022
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Job Description:
Overview
Join our team as a Manager of Medical Economics!!
The Manager Medical Economics will direct and manage specific
responsibilities within the medical economics department and
support the actuarial function, including, (1) Identifying cost
savings opportunities and leading actuarial analysis related to
short and long term cost reduction opportunities, (2) ensuring
opportunities are accurately measured, communicated to Senior
Enterprise Leadership (PHS Cost Leadership) and integrated into
pricing, and IBNR, (3) Responsible for the strategy, design,
ensuring accuracy (via collaboration with the AO/IT) of
applications and tools used by Medical Economics/Actuarial needed
to perform benchmarking analysis, pricing models, and financial
analysis (i.e. Milliman HCG, GRVU, and Medicare repricer), (4)
Responsible for the design, implementation, and accuracy of
analysis supporting provider contracting (including VBPs,
capitation, and pay for performance), (5) Responsible for the
design and development of tools and analysis to support pro-active
and retrospective provider payment accuracy and integrity.
Type of Opportunity: Full Time
FTE: 1.000000
Exempt: Yes
Work Schedule: Weekday Schedule Monday-Friday
Qualifications
Bachelors degree in Business, Finance, Accounting, Health
Economics, or Actuarial Science.
ASA certification or (completion within 1 year) plus four years
experience in underwriting/actuarial or pricing for managed care,
or eight-plus years experience in underwriting/actuarial or pricing
for managed care, including 3+ years of staff management. Associate
or Fellow of the Society of Actuaries (ASA/FSA) certification.
Credentials
Associate or Fellow of Society of Actuaries (ASA/FSA) designation
required
Key Skills Will Include
In-depth knowledge of health insurance products, concepts,
payments, analytics, benefits, and underwriting.
Experience with all lines of business, public/government programs
(Medicaid & Medicare), and private (Commercial)
Actuarial IBNR reserving and financial/budgeting analysis
Risk adjustment methodologies, concepts, and applications to
analysis
Predictive analysis and time series-based reporting and
projections
Technical actuarial pricing, as it relates to impacts from Medical
Economics-driven programs
Provider reimbursement calculation, quantification, and prospective
contracting support
Value-based contracting and risk-sharing, including
capitation/sub-capitation
Predictive modeling and analysis, and a knowledge of advanced
statistics
Determine innovative solutions for problems, leveraging actuarial
methods for determination
Prioritization of financial time-sensitive requests for information
with finite resources
Technical computer skills, including basic programming and database
manipulation skills such as SQL, SAS, and/or R
Essential
Education:
Bachelor Degree
Responsibilities
Leads and directs Med Econ actuarial analysts and the provider
contract performance team.
Cross-organization coordination on actuarial methods for
identification, analysis, and quantification (ROI & savings) of
opportunities in healthcare cost improvements for the strategic
business needs of the organization
Interface with Senior Management; take an active role in medical
cost reduction initiatives (including enterprise impacts) from a
financial perspective.
Month-End financial close support and analysis pertaining to IBNR,
reserves, profit, trend analysis, completion factor incorporation,
validation analysis, pricing review with initiatives.
Lead, provide recommendations, review, and develop analytics
solutions including consultative support as it pertains to Medical
Economics, Actuarial, and Financial applications.
Serves as a finance expert on healthcare costs, utilization and
trends. Educates internal and external customers on healthcare
costs, utilization, and trends.
Analytics and quantifications supporting of contracting/provider
payments, including value-based payments (VBP), risk-sharing,
capitation, pay-for-performance (P4P), quality incentives, and
additional innovative methods.
Benefits
We offer more than the standard benefits!
Presbyterian employees gain access to a robust wellness program,
including free access to our on-site and community-based gyms,
nutrition coaching and classes, wellness challenges and more!
Learn More About Our Employee Benefits
https://www.phs.org/careers/employee-benefits/Pages/default.aspx
Why work at Presbyterian?
As an organization, we are committed to improving the health of our
communities. From hosting growers' markets to partnering with local
communities, Presbyterian is taking active steps to improve the
health of New Mexicans. For our employees, we offer a robust
wellness program, including free access to our on-site and
community-based gyms, nutrition coaching and classes, wellness
challenges and more.
Presbyterian's story is really the story of the remarkable people
who choose to work here. The hard work of our physicians, nurses,
employees, board members and volunteers grew Presbyterian from a
tiny tuberculosis sanatorium to a statewide healthcare system that
serves more than 875,000 New Mexicans.
About Presbyterian Healthcare Services
Presbyterian Healthcare Services exists to improve the health of
patients, members and the communities we serve. We are a locally
owned, not-for-profit healthcare system of nine hospitals, a
statewide health plan and a growing multi-specialty medical group.
Founded in New Mexico in 1908, we are the state's largest private
employer with nearly 14,000 employees - including more than 1,600
providers and nearly 4,700 nurses.
Our health plan serves more than 580,000 members statewide and
offers Medicare Advantage, Medicaid (Centennial Care) and
Commercial health plans.
About New Mexico
New Mexico continues to grow steadily in population and features a
low cost-of-living.
Varied landscapes bring filmmakers here from around the world to
capture a slice of the natural beauty New Mexicans enjoy every day.
Our landscapes are as diverse as our culture - from mountains,
forests, canyons, and lakes, to caverns, hot springs, and sand
dunes.
New Mexico offers endless recreational opportunities to explore and
enjoy an active lifestyle. Venture off the beaten path, challenge
your body in the elements, or open yourself up to the expansive
sky. From hiking, golfing, and biking to skiing, snowboarding, and
boating, it's all available among our beautiful wonders of the
west.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer
with smoke-free campuses.
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Keywords: Presbyterian Healthcare Services, Albuquerque , Manager Medical Economics - Actuary, Executive , Albuquerque, New Mexico
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