Medical Economics Manager

Job DescriptionIn this role as a Medical Economics Manager, you will: Perform all aspects of value based contracting analytics in support of current and prospective VBCs for Aetna's Medicaid health plans. Oversees development and implementation of market specific provider compensation and reimbursement schedules. Oversees the production of both standard and ad-hoc reports used for Medicaid value based contracting. Partners and consults with Actuarial, 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. Provides hospital and physician contract audit and review support (i.e., provider practice analysis, BIR support). Develops tactical and strategic plans to satisfy information needs across products, segments and markets.Required Qualifications 5 or more years experience in managed care contacting and/or analytics.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 Excellent analytical and problem solving skills. Ability to manage conflicting priorities and multiple projects concurrently. Excellent written and verbal communication and presentation skills. Prior experience in Medicaid managed care preferred Knowledge of Aetna data warehouse or QNXT preferred 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. Advanced communication/presentation skills. Knowledge of market-place delivery (understanding of provider relationships) Advanced software and programming skills.Education Bachelor's Degree or equivalent work experience requiredBusiness 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