Medical Economics Manager - Work from Home Flexible

Job DescriptionThis fast-paced, high visibility, executive-focused analytical role will provide strategic assessments of emerging local market and national vendor relationships, evaluate national network contracts, and deliver differentiated non-participating (Out-Of-Network) provider determinations to support the overarching Medical Economic mission statement of reducing medical costs and medical costs trends to provide more affordable healthcare to Aetna and CVS Health members while improving quality and access.As part of the Medical Economics National (Non-Participating) team, you will have the opportunity to present key trends, financial performance, tools and analyses with a broad MEU audience (including direct exposure to VP-level leadership). The MEU National team is accountable for working collaboratively across MEU to analyze, draw conclusions, and communicate the financial impact resulting from changes in Aetna's non-participating policies, provider contracts, and vendor arrangements. Individual contributor that applies wide-ranging knowledge and experience of own job area within business unit or function, and may have advanced knowledge and practical experience of specific technical areas applied within the context of a similar industry or type of organization Works collaboratively to analyze, draw conclusions, and communicate the financial impact resulting from changes in Aetna's vendor arrangements, nonpar policies, and provider contracts. Set objectives and deliver results that have a significant impact within the context of a wider operational area Plans and sets objectives to deliver responsibilities that have a direct effect on the business results within the context of the functional area that the job is in Requires independent completion of work, where discretion is required within broader established operational boundaries of the function that job is in Recognized as subject matter expert Typically works independently and manages projects Requires strong communication skills, creating an environment of teamwork and continual process improvement internal to MEU and external constituents Provides Local Market support to Medical Expense Review teams on vendor, non-par and network topics Understands the financial implications of provider contract proposalsRequired Qualifications5 or more years of analytical experienceCOVID 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 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. Understanding of internal and external database applications. Knowledge of market-place delivery (understanding of provider relationships). Advanced communication/presentation skills. Advanced software and programming skills.Ability to prioritize & manage multiple projects while managing customer expectations and business prioritiesWork collaboratively and build relationships with colleaguesExperience working with Excel, MS-Access and Web-based query toolsComplex data collection, modeling & analysis.EducationBachelor's Degree or equivalent work experience required.Business 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: 2026-04-04