Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

Director, Medical Economics

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Director and Equivalent
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191CM Requisition #
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Direct a team of financial analysts who provide timely, accurate, actionable data and analysis supporting the department, area, and corporate key initiatives. Manage financial analysts to meet the key initiatives of the company.  Oversee the development of initiatives to increase profitability and decrease medical expenses.  Direct activities to execute the plans for provider financial analysis and manage the resources needed to successfully support business teams within the company.  Enhance and strategize for improved development of analytics for operating decisions and provide recommendations to senior management on both tactical and strategic nature.  Act as the key strategic member of Management in collaborative business teams, actively developing and maintaining relationships.

Responsibilities:
  • Direct and manage the Medical Economics staff to facilitate standard reporting and ad hoc analysis.
  • Manage and develop direct reports who include other  supervisory personnel and/or exempt individual contributors.
  • Ensure strategies and ensure maximum efficiencies in the utilization of human and financial resources.
  • Oversee the workflow of the financial analysts by prioritizing projects and establishing expectations with the department’s internal and external customers.
  • Lead and manage meetings to facilitate communications in regional initiatives to improve operating results.
  • Oversee Medical Economic projects and initiatives, direct all necessary follow-ups and communicate results and recommendations to senior management.
  • Originate new and unique approaches to solve complex projects/programs.
  • Govern and conduct monthly analysis identifying opportunities to reduce cost and utilization, to include review and dissemination of reports with summary overviews to highlight issues facing the organization.
  • Actively evaluate the government reimbursement process to determine areas of risk and opportunity and provide senior management with necessary updates and/or strategic recommendations
  • Manage the financial analysis of medical cost.
  • Take responsibility for the contract modeling process.
  • Develop and provide actionable recommendations to senior management relative to all analysis and/or ad hoc reporting.
  • Advise management in long-range planning for areas of specialization. 
  • Provide technical direction to functional managers, other directors and management.
  • Recommend changes in area(s) policy and procedure.
  • Participates in special projects and performs other duties as assigned.
Qualifications:
  • BA/BS Required in Mathematics, Economics, Healthcare or other quantitative discipline
  • 10 – 12 years’ relevant work experience required
  • 5-8 years of health care or industry experience, in positions of increasing responsibility required
  • Experience in staff and process management required
  • Strong skills in analytical/problem solving and presentations required
  • Effective presentation of reporting and analytic results, to all types and levels of audiences required
  • Knowledge of standard health care metrics for payer and provider reporting preferred
  • Proficient in MS Office applications (word processing, spreadsheet/database, presentation, Outlook) required
  • Advanced proficiency in SAS or SQL required
  • Knowledge of Tableau preferred

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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