Medical Economic Manager
Presbyterian Healthcare Services
Medical Economic Manager
Cooper,
United States•5mo ago
OnsiteCommercial Employer HealthMedicare AdvantageMedicaid
Role Summary
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Senior health-plan Medical Economic Manager in Albuquerque, NM. You will act as the financial expert for product lines (Commercial, Medicare, Medicaid), supporting pricing, identifying medical and pharmacy cost drivers, and reviewing monthly reserve (IBNR) analysis. The role partners cross-functionally with pricing, provider contracting, clinical ops, and finance.
JOB DESCRIPTION SUMMARY
- Act as financial expert for Commercial, Medicare, and Medicaid product lines
- Support pricing strategy and identify medical/pharmacy cost drivers
- Review monthly reserve (IBNR) and advise on emerging trends
- Work onsite at Reverend Hugh Cooper Administrative Center in Albuquerque, NM
- Requires 6+ years in medical economics/health plan analytics
DOMAIN EXPERTISE
- Medical economics and product performance analysis
- Health plan operations including population health and utilization management
- Provider contracting and value-based reimbursement experience
- Familiarity with ICD9/10, CPT, HCPCS, MS-DRG coding and PMPM metrics
- Reserve analysis (IBNR) and trend identification
KEY REQUIREMENTS
- 6 years healthcare industry experience in medical economics/product performance
- Bachelor’s degree in healthcare, accounting, finance or quantitative field
- Solid knowledge of health plan operations and provider contracting
- Experience with ICD9/10, CPT, HCPCS, MS-DRG, PMPM metrics
- Strong Excel/Access and BI tooling experience (e.g., Business Objects)
TECH STACK
- Excel
- Access
- PowerPoint
- Other_BI_Tool
