Aetna Medical Economics Manager in Hartford, Connecticut
Req ID: 53108BR
This position is responsible for managing a team of medical economics analysts & consultants that support Aetna's Joint Venture arrangements. The candidate will work collaboratively with business units across the Company, and directly with our hospital and physician partners, to provide medical cost driver analysis, medical costs savings opportunity analysis, complex financial modeling, and business decision support.
The team is engaged in all aspects of the analytic lifecycle, from contract negotiation through reconciliation & settlement, including report development and financial consulting support for provider partners.
Conduct analytical projects in support of Aetnas Joint Venture Strategy.
Provide analytical support for Joint Venture contract negotiations and on-going analytical support for active Joint Venture relationships.
Create actionable financial projections, decision support models, and financial reporting for new and evolving products, programs and initiatives.
Develop innovative analytics, insights and solutions for medical cost drivers, program valuation studies and network design/provider reimbursement issues.
Work directly with our provider partners and other internal units in designing and implementing evolutionary changes in Aetnas Joint Venture Strategy.
Perform financial reconciliations as part of JV contracts.
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.
Experience delivering presentations with high visibility.
Knowledge of market-place delivery (understanding of provider relationships.)
7 or more years of provider reimbursement analysis, medical cost analysis & health industry experience.
Demonstrated extensive and diverse knowledge of health care data, metrics, systems and standards.
Working knowledge of value based contracting concepts & methodologies
Strong problem solving, analytical, and project management skills.
Excellent written & oral communication skills.
Able to make sound decisions and recommendations to drive business solutions.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Functional - Information Management/Medical economics/7-10 Years
Functional - Information Management/Provides analysis and support for planning and forecasting of medical costs/4-6 Years
Functional - Network Management/Contract negotiation/1-3 Years
Functional - Information Management/Utilizes and maintains pricing models and medical cost tracking tools/4-6 Years
Technical - Aetna Applications/Enterprise Data Warehouse/7-10 Years/Power User
Technical - Database/Microsoft Access/4-6 Years/Power User
Technical - Desktop Tools/TE Microsoft Excel/7-10 Years/Power User
Finance/Managing Aetnas Risk/MASTERY
General Business/Turning Data into Information/MASTERY
Leadership/Collaborating for Results/MASTERY
General Business/Applying Reasoned Judgment/MASTERY
General Business/Communicating for Impact/MASTERY
Leadership/Engaging and Developing People/MASTERY
ADDITIONAL JOB INFORMATION
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna takes our candidates's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.
Job Function: Health Care