Medical Economics Analyst II

Job Summary:

The Medical Economics Analyst II is responsible for analyzing healthcare utilization to identify patterns, variation, and outliers as well as identify and quantify opportunities to reduce medical costs.

Essential Functions:

• Identify, quantify and model opportunities to reduce medical costs within the markets
• Evaluate the effectiveness of medical cost reduction initiatives
• Understand and calculate basic healthcare KPI’s
• Complete analytic process from start to finish and provide recommendations on medical cost savings initiatives
• Analyze healthcare utilization to identify patterns, variation, and outliers
• Develop tools to efficiently compare market performance across and within products
• Monitor the efficiency and efficacy of clinical programs, interventions and processes
• Support the intake, prioritization and coordinated execution of ad-hoc analytics requests from departments across the organization
• Identify the variables and methodologies (e.g., qualitative, quantitative, spatial) that define population cohorts that can be positively impacted through targeted programs and interventions
• Perform any other job duties as requested

Education and Experience:

• Bachelor’s Degree or equivalent years of relevant work experience is required
• Minimum of two (2) years of experience in healthcare analytics is required, health plan preferred
• Managed care experience is strongly preferred

Competencies, Knowledge and Skills:

• Knowledge of healthcare data, including medical and pharmacy claims, EMR data, HIE data, UM data and demographic data
• Knowledge of Medicaid, Medicare and other government sponsored healthcare programs is preferred
• Proficient in Excel (Power Query, Power Pivot), Word and PowerPoint
• Proficient with Transact-SQL or Microsoft Power BI
• Strong critical thinking skills
• Ability to organize data in a way that facilitates inferences, conclusions and decisions
• Demonstrated written and verbal communication skills

Licensure and Certification:

• None

Working Conditions:

General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

This job description is not all inclusive. CareSource reserves the right to …