Virginia Premier Health Plan, Inc.

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Manager, Medical Economics – Utilization Management & Pharmacy

Manager, Medical Economics – Utilization Management & Pharmacy

Job Locations 
US-VA-Richmond
Job ID 
2017-4385

Job Description

Overview

This position is responsible for developing an extensive expertise in the corporate data systems. Responsible for gathering requirements, performing analysis, supporting the development and testing of processes, and understanding and documenting the applications, data, and associated technologies for Utilization Management and Pharmacy sections of Medical Management.

 

The Medical Economics Manager is responsible for providing support with respect to understanding the utilization climate and its potential impact on Virginia Premier products. This position is accountable for evaluating, monitoring and proposing recommendations relative to CMS and private payer initiatives within the Virginia Premier portfolio, with an emphasis on the Medical Management programs/initiatives. Such duties will be consistent with, but not limited to, economic and utilization analyses that help demonstrate the clinical and economic benefits of the utilization of the company's programs.

 

Responsibilities

  • Support Director of Medical Economics in the development, presentation and execution of statewide corporate health economic strategies and economic tools (budget impact models, comparative analysis, root cause analysis, population management, etc.) to support development and drive appropriate corporate resource utilization.
  • Identify opportunities to develop economic analyses (i.e. cost-effectiveness, budgetary impact, programmatic outcomes measurement etc.) for key Lines of Business, and applicability of analyses corporately.
  • Design and maintain data structures and systems
  • Coordinate the training and growth of new analysts, and facilitate their growth within the company.
  • Monitor changes in the external environment (regulatory/reimbursement changes, managed care arrangements, etc.) and advise senior management on threats and opportunities with suggested action plans.
  • Assist in development of benchmark reports
  • Assist in the analysis and presentation of business opportunities
  • Participate in development and analysis teams with other managers (including managers of other organizations)

Qualifications

MINIMUM EDUCATION REQUIREMENTS

  • Bachelor’s Degree in Business, Health Administration, Mathematics, Information Systems, or related field

SPECIAL KNOWLEDGE AND/OR SKILLS

  • Strong project management skills.
  • Strong analytical and prioritization skills with the ability to manage several projects simultaneously.
  • Highly analytical thinking with demonstrated talent for identifying, scrutinizing, improving, and streamlining complex work processes
  • Must be able to perform under pressure and in a very dynamic environment
  • Have a high degree of initiative, motivation and passion for the business.
  • Excellent interpersonal skills and strong strategic management skills.
  • Work, direct, and take direction with all levels of management
  • Ability to understand complex disease states and technical product information
  • Perform in a diverse cross-functional team environment.
  • Advanced personal computer skills, including experience with Microsoft Office.
  • Performs complex data analysis using traditional and non-traditional statistical methods
  • Ability to analyze complex problems and develop multiple workable solutions
  • Demonstrates an active interest in enhancing current skills and learning new ones; applies advanced functional or technical knowledge to do his or her job at a high level of accomplishment
  • Chooses appropriate tools or technology for tasks; improves or redesigns processes, tools, or technologies to determine applicability
  • Highly skilled in writing queries that join multiple data sources and complex data manipulation
  • Consistently shares expertise with others, teaching skills and explaining concepts
  • Leads analytical team.  May lead multi-functional teams.
  • Coaches others
  • Demonstrated experience in troubleshooting complex problems
  • Organized, on-time, and detailed project management skills.
  • Energized attitude.

 WORK BACKGROUND/EXPERIENCE

  • Required: Minimum 3+ years of experience in data analysis and/or report development
  • Preferred: Minimum 3+ years of experience in healthcare (preferably government programs), business analysis or application development/implementation
  • Six Sigma Green Belt preferred.

PHYSICAL REQUIREMENTS

  • Physical health sufficient to meet the ergonomic standards and demands of the position.

About Us

Virginia Premier Health Plan, Inc. is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs.  Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia. 

 

We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.  

 

All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

 

Our mission is to inspire healthy living within the communities we serve!

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