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CVS Health Medical Economics Manager in Bethesda, Maryland

Job Description

This role is open to anywhere in the USA

Provides oversight of all activities related to utilization and unit cost management in support of the organization’s strategy as it relates to Student Health business. Provides analysis to senior management to support strategic and tactical operating decisions

Fundamental Components

· Responsible for building corporate expertise and reporting on all medical cost drivers of the Student Health business

  • Build medical cost analytics best practices and provide analytical support for Student Health business

  • Develop and maintain Medical Expense Review process to support identification of utilization and unit cost initiatives for Student Health business

  • Work cross-functionally to ideate and implement medical cost savings initiatives

  • Responsible for developing and reviewing utilization and medical cost metrics to identify outliers and keep senior management informed

  • Develop and present actionable recommendations to management based on analyses

  • Participate in research-related activities including industry best practices and experience studies

  • Partner with finance and actuarial to help explain variances in financial results vs. expectations

  • Participate in monthly National SAI calls and weekly MEU SAI calls in order to share ideas and be the voice for SH

  • Partner with MEU Tools & Reporting team to create SH reporting consistent with other commercial business, and investigate data / platform differences

  • Manages and develops provider reimbursement programs, policies, and strategies to ensure unit cost controls meet or exceed corporate objectives for medical cost containment.

  • Provides analytical support critical in positioning system or network changes necessary to enhance market share, competitive position.

  • Provides hospital and physician contract audit and review support (i.e., provider practice analysis).

  • Develops tactical and strategic plans to satisfy information needs across products, segments and markets.

  • Understanding of internal and external database applications.

  • Full comprehension of provider contracts and the potential impact the regulatory/legislative environment has on reimbursement strategies.

  • Extensive knowledge of managed care and how provider reimbursement policies relate to the control of medical claims costs.


Background Experience

  • Required:

  • Bachelor's degree along with 6+ years’ experience in managed care analytics

  • Excellent analytical and problem solving skills

  • Strong organizational and project management skills

  • Ability to manage conflicting priorities and multiple projects concurrently


Bachelor's degree or equivalent experience

Percent of Travel Required

0 - 10%

Business Overview

Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.