Manager, Medical Economics

This is a fully remote position, open to applicants in Tennessee.

📋 Description

• Take charge of the development and creation of Chamber’s clinical impact reporting.

• Establish reporting infrastructure, methodologies, and narratives that showcase program effectiveness to payers, partners, and leadership.

• Develop and sustain SQL-based analytical processes and dashboards that encompass medical claims, pharmacy claims, enrollment, and attribution data.

• Lead the analysis of cost trends, utilization impacts, clinical effectiveness, and operational and economic efficiency.

• Define the metrics and methods by which Chamber conveys health economics success.

• Collaborate with senior executives, serving as a vital analytical stakeholder.

• Expand the Medical Economics team and analytical platform in alignment with business growth.

• Navigate ambiguous data and requests to generate defensible, actionable results.

• Utilize SQL, Excel, AI tools such as Claude, and PowerPoint to conduct thorough and accessible analyses.

• Audit Chamber’s health economics data landscape and identify gaps.

• Create and improve reporting and dashboards for existing risk contracts.

• Provide cohort efficacy reporting on Transitions of Care and Medication Adherence, including inpatient utilization and medication therapy impact.

• Present performance reviews to senior leadership, highlighting data reliability, analytical gaps, and strategic priorities.

⛳️ Requirements

• A minimum of 4 years of experience in medical economics, health economics, or a related analytics or actuarial role.

• Proficient understanding of value-based care performance metrics, such as TCOC, avoidable inpatient utilization (APK), utilization benchmarks, quality measures, medication adherence, and economic efficiency indicators.

• Expertise in SQL, Excel, and PowerPoint.

• Comfort with AI prompting tools in the analytical workflow.

• Familiarity with CMS value-based care models, including MSSP and REACH.

• Knowledge of CMS-HCC risk adjustment and CMS quality scores.

• Capability to manage analytical projects from start to finish, including hypothesis formation, analysis design, and results communication.

• High tolerance for ambiguity, with the ability to produce clear, defensible, and useful outputs from complex data and vague briefs.

• Excellent written and verbal communication skills.

• Strong critical thinking abilities and a resourceful operating style.

• Bachelor’s degree in health economics, public health, biostatistics, or a related field.

🏝️ Benefits

• Option for remote work.

• Hybrid work option available in Nashville.

• Flexibility to work ET or CT hours.