Gateway Health Plan
Job Description :
This job develops, coordinates and manages medical economics analysis, models, health outcome studies and related forecasting and actual results analysis related to the portfolio of activities that are focused on operating margin improvements, primarily focused on medical spend. This work will leverage market-leading health plan medical economics processes, tools and reporting. The incumbent serves as the key link between the Finance/Actuarial work in support of these initiatives and each business segment and functional area partners’ work, with focus on the coordination of infrastructure development to link initiatives with financial plans/forecasts, emerging results and pricing infrastructure and process development to link medical economic related analytics (trend reporting, medical cost, conditions, etc.) with business partner actions, including progress and impact and function as point person for all business segment medical economic analytics. Manages the matrix-specifically business partners and those support functions- who have accountability to implement initiatives in the portfolio. Reports into the Finance Organization; however, significant emphasis will be placed on frequent and meaningful interactions with business segment and functional department executive/senior leadership to ensure that earnings improvement initiatives are identified and executed in a timely manner. The incumbent interacts with Management (SVPs, VPs, Directors, etc.) in formal and informal situations, and must demonstrate a high-level of analytical, communications and influence skills.
- Coordinate the oversight and monitoring of the “Creating Customer Value” operating margin improvement effort, driving cross-functional team work efforts to identify, design, implement and monitor initiatives that improve the Organization’s revenue, claims and administrative expenses.
- Use medical economics experience and knowledge to facilitate idea generation and quantification of savings initiatives (areas of focus include provider contracting, utilization management, care management, risk adjustment, operational efficiencies, product design, etc.). Provide timely insight into claim cost drivers for the business segment leaders and identification of new improvement opportunities. Understand the larger medical cost picture, and create process to identify and quantify interactions and dependencies of the different initiatives.
- Use medical economics experience and knowledge to develop and implement infrastructure to align and explicitly link initiatives’ savings estimates with the financial plans/forecasts, emerging financial results and product pricing.
- Partner with Finance, Actuary, FP&A and the business and functional partner leaders to ensure that the initiatives are appropriately contemplated in current/future year projections and pricing models as well as monitored in the emerging financial results. Coordinate savings opportunity projections and post implementation savings measurement with other areas.
- Regularly interact with Senior Finance leadership, including the Chief Actuary and CFO, as well as other leadership and staff, to set and adjust overall goals and objectives of the process.
- Provide greater ability to more timely engage, analyze, and implement beneficial but complex financial arrangements with new vendor business partners.
- Help develop and implement improved infrastructure and processes to provide management with regular performance scorecards highlighting initiative implementation successes, accountability, “capture” of initiative benefits, activity, progress and identification of barriers.
- Consistently work with the business and functional area partners to develop a pipeline of new initiatives, seeking to achieve our multi-year financial improvement targets. This effort focuses on operating margin improvement and is positioned to become a normal part of the way the organization does business, and will exist on-going every year.
- Train business partners in the use of business case return on investment measurement, developing a self-service culture that enables a broad base of support to initiative owners in their efforts to identify potential operating margin improvement initiatives.
- Develop improved business case and savings estimate capabilities to enable more accurate and deeper projections.
- Assist in the deployment of an employee-wide communications strategy, highlighting the operating margin improvement challenge and providing regular status reports with respect to achievement of targeted improvements.
- Lead in a matrixed work environment.
- Influence other departments where you do not have direct authority.
- Help drive a culture change from “reporting the past” to “creating the solutions for future.”
- Be persistent in following up with senior management and staff from numerous departments.
- Collaborate with P&L owners and functional leaders. This will require strong communication skills (verbal and executive quality presentations).
- Be able to determine when projections seem unreasonable and constructively push back until satisfied with the analysis.
- Other duties as assigned or requested.
- 5 years of progressive experience in Finance, Accounting or Analytics/Informatics with experience in Healthcare and a focus on Medical Economics
LICENSES AND CERTIFICATIONS
- Medical economics
- Financial analysis/modeling
- Statistical/quantitative modeling
- Executive communication
- Direct report development/talent management
- Collaboration across matrix organizational structure
Languages (Other then English)
0% – 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Teaches / trains others regularly
Travel regularly from the office to various work sites or from site-to-site
Works primarily out-of-the office selling products/services (sales employees)
Physical work site required
Lifting: up to 10 pounds
Lifting: 10 to 25 pounds
Lifting: 25 to 50 pounds
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org
California Consumer Privacy Act Employees, Contractors, and Applicants Notice