QAI Medical Economics Analyst II

Job Summary:

The Medical Economics Analyst II is responsible for analyzing healthcare utilization to identify patterns, variation, and outliers as well as identify and quantify opportunities to reduce medical costs.

Essential Functions:

• Identify, quantify and model opportunities to reduce medical costs within the markets
• Evaluate the effectiveness of medical cost reduction initiatives
• Understand and calculate basic healthcare KPI’s
• Complete analytic process from start to finish and provide recommendations on medical cost savings initiatives
• Analyze healthcare utilization to identify patterns, variation, and outliers
• Develop tools to efficiently compare market performance across and within products
• Monitor the efficiency and efficacy of clinical programs, interventions and processes
• Support the intake, prioritization and coordinated execution of ad-hoc analytics requests from departments across the organization
• Identify the variables and methodologies (e.g., qualitative, quantitative, spatial) that define population cohorts that can be positively impacted through targeted programs and interventions
• Produce and maintain quarterly forecast projections for medical cost initiative reductions
• Perform any other job duties as requested

Education and Experience:

• Bachelor’s Degree or equivalent years of relevant work experience is required
• Minimum of two (2) years of experience in healthcare analytics is required, health plan preferred
• Managed care experience is strongly preferred

Competencies, Knowledge and Skills:

• Knowledge of healthcare data, including medical and pharmacy claims, EMR data, HIE data, UM data and demographic data
• Knowledge of Medicaid, Medicare and other government sponsored healthcare programs is preferred
• Basic ability to analyze and interpret financial data in order to incorporate into analyses/reports
• Proficient in Excel (Power Query, Power Pivot), Word and PowerPoint
• Proficient with Transact-SQL or Microsoft Power BI
• Strong critical thinking skills
• Ability to organize data in a way that facilitates inferences, conclusions and decisions
• Demonstrated written and verbal communication skills

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Fostering a Collaborative Workplace Culture

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.