Director, Healthcare Economics

About the role

The Director, Healthcare Economics leads the Healthcare Economics, Actuarial, and Analytics department, overseeing analysis of healthcare cost trends, medical costs, financial forecasting, budgeting, and program evaluation/ROI calculations for the health plan. This role develops and presents financial and programmatic recommendations to protect the organization’s financial integrity, improve healthcare affordability, and support corporate cost management goals, new initiatives, and financial solvency. The position involves interpreting data, utilizing national and local information sources, and collaborating with internal staff, external vendors, and regulators.

Responsibilities

• Directs the development and design of analyses regarding medical utilization, cost and quality trends, and provider reimbursement models.
• Oversees the development, delivery, and maintenance of regular financial and clinical trend projections.
• Directs the ongoing evaluation of clinical and financial programs using both industry-standard and novel statistical methods.
• Delivers effective presentations of findings and recommendations, in oral and written format, to internal staff, management, and external customers.
• Stays abreast of healthcare topics and trends, including physician and facility reimbursement, quality reporting, healthcare reform, epidemiological trends, and alternate payment models.
• Advises leaders on the development and implementation of new programs, processes, and procedures to achieve financial goals, with a focus on continuous improvement.
• Forecasts health plan margin strategy requirements.
• Conducts trend-drivers analysis to support pricing, forecasting, opportunity identification, and program development.
• Systematically identifies and eliminates data biases to ensure all proposals support health equity.
• Designs, implements, and maintains medical expense trend models, including cross-functional collaboration and information sharing.
• Ensures efficient, scalable use of available software in the development of data sets and models.
• Develops and maintains appropriate technical expertise within the department.
• Identifies and manages departmental goals consistent with corporate objectives.
• Establishes individual annual performance goals for staff, guides staff in setting learning and development plans, assesses performance, and determines merit, promotional, and recognition salary increases.
• Ensures efficient management of the department and promotes continual process improvement.
• Mentors and develops staff to take leadership roles.
• Ensures consistent policies and procedures are utilized across regions.
• Identifies emerging issues that impact corporate, divisional, or departmental goals.
• Maintains high standards of integrity, supporting the organization’s mission and values.
• Maintains high regard for member privacy in accordance with corporate privacy policies.
• Stays knowledgeable of relevant legislative and regulatory mandates and ensures compliance.
• Conducts periodic staff meetings, including timely distribution and education related to departmental and Ethics/Compliance information.
• Performs other functions as assigned by management.

Requirements

• Eight (8) years of relevant experience in a healthcare environment, with at least three years of leadership experience.
• Bachelor’s degree in mathematics, statistics, actuarial science, healthcare informatics, or related field. In lieu of a degree, six (6) additional years of experience required.
• Master’s degree preferred.
• Demonstrated success collaborating across divisions with technical, non-technical, and clinical stakeholders.
• Proven ability to analyze trends and translate data into actionable strategies.
• Comprehensive knowledge of financial planning and risk assessment.
• Advanced skills including proficiency in Microsoft Office, SAS, and Cognos.
• Advanced verbal and written communication skills, with the ability to present clear and concise information to all audiences.
• Ability to design and implement process improvements.
• Demonstrated advanced leadership and project management skills.
• Ability to translate technical concepts into business language.

Physical Requirements

• Ability to work prolonged periods sitting and/or standing at a workstation and working on a computer.
• Ability to travel across the Health Plan service region for meetings and/or trainings as needed.

Pay

Compensation range: Minimum $128,571 - Maximum $231,429. Actual salary will vary depending on factors including budget, prior experience, knowledge, skill, education, and internal equity.

Benefits

• Group health and/or dental insurance.
• Retirement plan participation.
• Wellness program.
• Paid time away from work and paid holidays.

Schedule

The opportunity for remote work may be possible on a case-by-case basis.