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Manager Medical Economics - Actuary

Company: Presbyterian Healthcare Services
Location: Albuquerque
Posted on: May 14, 2022

Job Description:

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
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.
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
Bachelor Degree
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.
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
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.

Keywords: Presbyterian Healthcare Services, Albuquerque , Manager Medical Economics - Actuary, Executive , Albuquerque, New Mexico

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