Manager, Healthcare Economics

Pediatric Associates was founded in Hollywood, FL in 1955. The same clinician-led, evidence-based, medical home passion is a unifying driver for those who join Pediatric Associates Family of Companies. The Pediatric Associates Family of Companies is a growing team of Pediatricians and Pediatric Care Teammates who are excited to be part of the first nationwide Pediatric Primary Care Medical Home. We further our uniqueness by ensuring the clinician voice is leading our medical home innovations.

Remote Opportunity

PRIMARY FUNCTION

The Manager, Healthcare Economics is responsible for developing population, cost, utilization, and trend statistics and reports to enable the management of the risk-based contracts. This role will require collaboration with cross-functional teams, including clinical, FP&A, managed care, and operations, to provide insights into underlying trends, support sizing operational improvements, and measuring the financial return.

ESSENTIAL DUTIES AND RESPONSIBILITIES

This list may not include all of the duties that may be assigned.

Develop and deliver unit cost and utilization statistic reporting which monitors trends and identifies outliers where reporting can be filtered under different variables such as diagnosis group, facility, provider type, service type, patient group, and region group.

Develop population normalized benchmark statistics to allow for comparisons against actual performance, identify outliers and opportunities for efficiency improvements.

Lead meetings with leadership to discuss trend drivers using the analyses generated and make recommendations on possible solutions and where improvements can be realized.

Collaborate with clinical stakeholders to identify and quantify medical cost savings opportunities inclusive of organizational expenses. Collaborate with finance stakeholders on translating cost savings opportunities into financial reporting packages.

Support measuring the effectiveness of programs and tracking progress including defining the measurement basis, data required, time period for analysis, and documenting data and analysis limitations.

Collaborate with the managed care and data organizations on required data transfers and the development of the internal consumption layers which enables value based care analysis and reporting. This role will help ensure the consumption layers are accurate and controlled and will address file and field related issues such as ingestion, mapping, controls, and remediation.

This role will involve moderately complex to complex issues where the analysis of situations requires in-depth data analysis and consideration of variable factors. Critical skills for this role will be possessing the ability to perform data analysis, development of reporting which enables identification of trends and underlying drivers, and estimating the financial return for clinical programs. This role will require being flexible and a collaborative business partner in a growing organization.

QUALIFICATIONS

EDUCATION: Bachelor's Degree in Math, Statistics, Healthcare Economics or equivalent combination of education and work experience required.

EXPERIENCE: A minimum of 10 years of healthcare economic professional experience.

KNOWLEDGE, SKILLS AND ABILITIES

Required qualifications:

• In-depth understanding of medical economics principles, including healthcare cost analysis, reimbursement methodologies, risk stratification and financial performance metrics.
• Experience in conducting medical cost trend analysis, utilization review, and forecasting to support strategic decision-making.
• Proficiency in modeling software and statistical analysis tools (e.g. Excel, SQL, SAS, R, Python)
• Strong communication skills, including the use of exhibits and presentations to translate technical issues for non-technical audiences.

Preferred Qualifications, in addition to the required qualifications

• 7 years of experience in a value based care contracting
• Experience in monitoring the performance of provider contracts
• Experience in Managed Medicaid
• Experience with predictive modeling techniques to forecast future healthcare costs, utilization patterns, and population health outcomes.
• Ability to think holistically through a project

TYPICAL WORKING CONDITIONS

• Non-patient facing
• Full time remote
• Job must be U.S. based

OTHER PHYSICAL REQUIREMENTS

• Vision
• Hearing
• Sense of Touch
• Manual Dexterity to operate a computer

PERFORMANCE REQUIREMENTS

Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI (Protected Health Information) in accordance with organizational policy, Federal, State, and local regulations.

The Pediatric Associates Family of Companies an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.