VP, Medical Economics

JOB DESCRIPTION Job Summary Provides executive level strategy and leadership for team responsible for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities, and improve financial performance and outcomes. Collaborates with health plans to develop scoreable action item (SAI) tracking tools and identify opportunities to improve performance and data management, and support, guide and influence decision-making related to clinical programs, initiatives and strategy. Essential Job Duties u2022 Regularly unpacks detailed medical cost information to identify significant trends development and underlying causes of those trends. u2022 Supports executive strategy development, vision and direction for the enterprise medical economics function including SAI analytics, governance and trend mitigation. Demonstrates accountability for performance and financial results, and keeps executive leadership apprised. u2022 Recruits, hires, onboards, mentors, develops, and manages a team of medical economics team of professionals. u2022 Collaborates with senior level clinicians and leaders from functional areas such as finance, health care services and provider contracting to translate analytic observations into meaningful clinical/operational actions and management of clinical services to support, guide and influence decision making related to clinical programs, initiatives and strategy. u2022 Leveraging targeted analytics, works with business leaders to develop programs to support affordable, high quality health care delivery. u2022 Identifies gaps in critical information and works with business leaders to develop solutions to capture or supplement information required. u2022 Informs and supports regular forecasting activities of the enterprise. u2022 Propagates best medical economics/analysis/SAI development practices across the enterprise. u2022 Leads enterprise information management (EIM) team to build out data analytic tools and capabilities. u2022 Develops standards with regard to routine health care economics analyses, including types of analyses performed, frequency by health plan or line of business, etc. Required Qualifications u2022 At least 12 years of health care analytics and/or medical economics experience, including 3 years of experience at an executive level, or equivalent combination of relevant education and experience. u2022 At least 7 years management/leadership experience. u2022 Bacheloru2019s degree in statistics, mathematics, economics, computer science, health care management or related field. u2022 Extensive experience in a leadership position in health care economics, preferably with complex organizations. u2022 Ability to effectively communicate and persuade technical and non-technical stakeholders, and engage with various levels within the organization u2022 Demonstrated ability to work with sophisticated analytic tools and datasets. u2022 Demonstrated ability to convert observations into actions/interventions to improve financial performance. u2022 Advanced understanding of Medicaid and Medicare programs or other health care plans. u2022 Advanced analytical work experience within the health care industry (i.e., hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.) u2022 Advanced proficiency with retrieving specified information from data sources. u2022 Advanced experience with building dashboards in Excel, Power BI, and/or Tableau and data management. u2022 Advanced understanding health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) u2022 Advanced understanding on health care financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form). u2022 Advanced understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRGu2019s), Ambulatory Patient Groups (APGu2019s), Ambulatory Payment Classifications (APCu2019s), and other payment mechanisms. u2022 Advanced understanding of value-based risk arrangements u2022 Advanced experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in health care. u2022 Advanced problem-solving skills. u2022 Strong critical-thinking and attention to detail. u2022 Excellent verbal and written communication skills. u2022 Proficient in Microsoft Office suite products, advanced skills in Excel (VLOOKUPs and pivot tables)/applicable software program(s) proficiency. Preferred Qualifications u2022Experience in complex managed care. u2022 Associate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries (FSA). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $186,201.39 - $363,093 / ANNUAL Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Created: 2025-11-15