Lead Economic Engineer of Medical Strategy

The Lead Economic Engineer of Medical Strategy is a highly visible and cross-functional role, working with business leaders across the organization to help deliver medical cost savings. This position will push the boundaries of traditional analytics and leverage financial and operational data to provide critical insights to answer questions and produce actionable output that that will drive cost actions and have direct impact on the profitability and growth of the company. The Lead Economic Engineer of Medical Strategy will work daily with multiple teams and senior leaders to provide industry knowledge and share insights on key drivers and metrics to be used in data-driven decision making.

The position will call upon a broad understanding of health services research, health economics and health policy, as well as very technical nuances of various pricing and actuarial methods. The ability to develop true trend analysis using regression analysis and other actuarial methods is critical and will help to identify drivers in medical costs. This position will lead the development of business requirements and analysis for various medical cost actions. Discussions with leadership and clinical staff must be interpreted and put into detail programming code. Strong skills in Structured Query Language (SQL) are necessary to be able to pull data from a variety of sources including claims and enrollment files that will be in a format for getting answers to business questions. Super user skills are also necessary in Excel, including the use of data extraction, manipulation, pivot tables, graphs, and other advanced features.

This position will be expected to lead and mentor junior analysts and assumes technical leadership role to analyze complex data and information to provide meaningful results, identify success factors and improvement opportunities, suggest potential solutions, and help internal stake holders set strategic directions. This role reports to the Director of Strategic Finance and is directly involved in all facets of the company's daily operations. Responsible for ensuring that all information generated complies with company regulations and for complying with all policies regarding federal, state, and local regulations.

Duties and Responsibilities:

Responsibilities include, but are not limited to, the following:

• Work closely with the Clinical Support Team, including the Chief Medical Officer and the Director of Medical Cost Action to advance medical cost actions for the company, develop, analyze, and present areas that are driving medical costs and brainstorm on potential solutions. May take direction from this team from time to time to help advance strategies.
• Meet with members of senior leadership and MCA committee to discuss existing actions, potential actions, and areas of opportunity that will impact expenses.
• Meet with internal and external SMEs to understand healthcare cost trends, identify industry best practices, and maintain awareness of regulatory issues that impact medical costs.
• Assist Director of Strategic Finance as necessary, including but not limited to review and help to drill down on oversight of monthly variance information, and potential risks and opportunities relative to budget/forecast projections.
• Analyze complex information, develop reports to provide accurate in-depth analysis, and make timely recommendations to Medical Cost Actions team and operational leaders for decision-making. This will involve the understanding of and breaking down of requirements into a detailed understanding of data elements and writing SQL code to be able to extract the necessary data.
• Lead the design and develop analytical methodologies for the evaluation of clinical programs, provider performance, provider-based initiatives and other managed care programs aimed to reduce costs and improve quality of care.
• Analyze administrative claims data to answer health services research questions on member risk, costs, utilization, or outcomes, using advanced statistical and econometric methods.
• Participate and support data governance activities and goals.
• Act as data or analysis SME where appropriate within the organization.
• Maintain knowledge and common practices of industry around managed care.
• Other related duties as required.
• Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood's Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies, and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect, and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents.

Qualifications

Required:

• Bachelor's degree with a quantitative emphasis, including business, actuarial science, quantitative social science, mathematics, statistics, or computer science.
• Seven (7) + years of progressive industry experience in data analysis methods, including a strong command of health insurance economics and medical cost drivers.
• Knowledge of healthcare industry including familiarity with health policy, health insurance, benefit plans and product features, provider contracting approaches, reimbursement approaches and health management approaches.
• Five (5) + years of SQL coding experience.

• Five (5) + years of data analysis experience using various analysis tools (SQL or SAS), including analyzing trends, their components (Utilization/Mix, Price, Seasonality, etc.), and other actuarial concepts.
• Full comprehension of provider contracts and the potential impact the regulatory/legislative environment has on reimbursement strategies
• Demonstrated ability to evaluate quantitative data from multiple sources using statistical modeling, analytical methods, and critical thinking skills. Expertise in building and maintaining financial models and complex datasets. Ability to learn new technologies and analytic approaches.

• Advanced (Super User) skills in Excel, including the use of pivot tables, use of formulas for advanced calculations and financial modeling, and the creation of graphs and other data visualizations to effectively communicate the trend story.

• Strong data extraction and analysis skills, including SQL Coding experience, are needed to run ad-hoc analyses to answer specific clinical or financial questions. Essential skill as reporting "super user" to be able to easily navigate, comprehend, and tease out findings with a variety of enterprise reporting tools.

• Experience in translating business requirements and being able to translate them into technical requirements and code. This will be critical as business needs are expressed by the Medical Cost Action group that need to be put into actionable analysis.

• Advanced analytical and problem-solving skills exhibited by the ability to approach complex, ambiguous business issues with creative ideas and solution.
• Superior communication, facilitation, and presentation skills.

• Exceptional strategic thinker, ability to influence strategic business decisions by providing financial guidance and participation on committees and project groups. Demonstrates initiative, innovation, and leadership in achieving results.

• Detail oriented with high standards of accuracy.

• High level organizational and project management skills to be able to effectively handle concurrent assignments and conflicting priorities. Ability to work in a fast-paced, but sometimes intense, rapidly expanding company.

• Comfortable working in a professional, diverse corporate setting

Preferred:

• Previous working experience in a Managed Health Care environment
• Prior healthcare pricing experience (Underwriting, Actuarial, Network Management, or product development) is preferred.
• Project management or project experience is preferred to be able to work through multiple priorities and inputs across a multitude of business areas.

Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.