Manager, Medical Cost Management

HealthCare Support is actively seeking a Manager, Medical Cost Management to fill an opening with one of the nation’s largest managed care organizations. This is a primarily remote role.

Daily Responsibilities for Manager, Medical Cost Management:

• Manage and lead the Enterprise Medical Expenditure Trend Committee process and collaborate with leaders in Analytics and Network, Medical Policy and Clinical Operations, as well as Value Based Programs, to review and identify new business trends and work together to develop solutions to mitigate them.
• Collaborate with Enterprise Behavioral Health owners to drive financial performance by managing vendors, designing and evaluating new and existing programs, utilizing advanced analytics and reporting tools, managing network financial management and developing medical cost action plans;
• Responsibilities Include Budgeting, Forecasting, Operations Finance, Development of Analytics and Strategic Investment. Manage and support Health Care Management and Technology (HCM&T) initiatives across the Enterprise related to Network Initiatives and Optimization, Medical Cost Action Plan Development and Validation, Vendor Return-On-Investment Evaluations, Value Based Program Development and Risk Transfer.
• Develop and produce and continue to enhance the HCM&T Monthly Operating Report and work with HCM Network team to identify drivers of the network unit price and develop network strategic initiatives
• Responsible for reporting, tracking and challenging HCM business metrics across the enterprise to meet the P&L objectives
• Other responsibilities as assigned
  
  
  

Required Qualifications for Manager, Medical Cost Management:

• High School Diploma/GED required
• 8+ years’ experience in managed health care / health insurance industry
• 5+ years of analytical/financial experience
• Requires a successful track record in leading cross functional teams in large, multifaceted initiatives across an organization.
• 5+ years of experience using data analysis tools such as SQL, SAS and Excel
• Knowledge of the following is preferred but not required: Contracting concepts and various provider reimbursement methodologies, regulatory environment, state specific laws, mandates and regulations, incentive and value based contracting concepts, and New Jersey hospital and physician community.
  
  
  

Benefits for Manager, Medical Cost Management:

• Medical Dental Vision
• PTO & Paid Holidays
• 401K eligibility with employer match
• Other Company Perks Available
  
  
  

Pay Details: $107k - $145k/yr heavily dependent on experience and qualifications

Interested in being considered?

If you are interested in applying to this position, please click Apply Now for immediate consideration.

For additional consideration, please email a copy of your resume to Nicole Black - [email protected] with your phone number, the title of Manager, Medical Cost Management and location, and our recruiters will reach out.

Healthcare Support Staffing, LLC is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.

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