Medical Economics Manager

Job DescriptionThe Medical Economics Manager will: Oversees development and implementation of market specific provider compensation and reimbursement schedules, to include unit cost modeling Oversees the production of both standard and ad-hoc reports used for risk assessment analysis, budgeting, and hospital chargemaster analysis and forecasting. Partners and consults with Network, Patient Management and Segment teams to provide medical cost analysis to assess effectiveness of managing costs creating and implementing plans to effectively manage medical costs based on analysis or trends. Selects and builds strong team through formal training, diverse assignments, coaching, mentoring and other development techniques. Provides hospital and physician contract audit and review support (i.e., provider practice analysis, BIR support). Conducts stop loss reviews and supports overpayment and recovery efforts. Coordinates rate approvals and develops pricing for most complex contractual arrangements. Develops and communicates tactical and strategic plans to satisfy information needs across products, segments and markets to a broad audienceRequired Qualifications5 or more years of healthcare and/or analysis experience.COVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications Ability to manage conflicting priorities and multiple projects concurrently. Strong analytical ability and familiarity with advanced financial and healthcare concepts. Advanced software and modeling skills. Advanced skills in Excel, MS-Access and Web-based query tools(MCM, data warehouse). Ability to learn new technologies. Strong ability to communicate modeling results to a broad audienceEducationBachelor's Degree or equivalent experienceBusiness OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2025-11-15