Director, Medical Economics - REMOTE

JOB DESCRIPTION
Job Summary

Leads and directs Strategic and Clinical Analytics team members in Medical Economics who are responsible for healthcare analytics and program evaluation, translating complex data into actionable insights that inform clinical, operational, and strategic decision-making. Partners with clinical and enterprise stakeholders to define priorities, address critical business questions, and identify opportunities to improve health outcomes and financial performance. Provides analytical leadership and develops sound approaches to advance population health and healthcare program performance.
Essential Job Duties

- Leads teams responsible for analytics and evaluation of care management, utilization management, and other clinical and population health programs.

- Partners with clinical leaders and enterprise stakeholders to identify business questions, define analytical approaches, and provide insights and interpretation to support decision-making.

- Designs and conducts evaluations of healthcare programs to assess engagement, clinical, and ROI outcomes.

- Applies advanced methodologies, including causal inference, predictive modeling, and analysis of heterogeneous treatment effects, to evaluate program impact and identify opportunities for improvement.

- Develops population health analytics to identify members at high risk for unfavorable outcomes and those most impactable through targeted clinical interventions.

- Translates complex analytical results into clear, actionable recommendations for clinical, operational, and enterprise partners.

- Leads development of analytical strategies and frameworks to support program optimization, prioritization, and resource allocation.

- Collaborates with cross-functional partners to develop metrics, measurement approaches, and analytic tools for monitoring program performance and outcomes.

- Provides analytical oversight and guidance for high-priority initiatives, ensuring rigorous methodology, meaningful interpretation, and alignment with business and clinical objectives.

- Recruits, hires, onboards, mentors, develops, and manages analytics staff.

- Leads teams in the development and delivery of analytics, reporting, and evaluation capabilities that address enterprise priorities.

- Coordinates projects involving employees across functional and enterprise areas.

- Stays abreast of professional developments, emerging analytical methodologies, healthcare trends, and advances in population health and clinical program evaluation

Required Qualifications

- At least 8 years of health care analytics and/or medical economics experience, or equivalent combination of relevant education and experience.

- At least 3 years management/leadership experience.

- Bachelor’s degree in statistics, mathematics, economics, computer science, health care management or related field.

- Advanced understanding of Medicaid and Medicare programs or other health care plans.

- Advanced analytical work experience within the health care industry (i.e., hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.)

- Advanced proficiency with retrieving specified information from data sources.

- Advanced experience with building dashboards in Excel, Power BI, and/or Tableau and data management.

- Advanced knowledge of health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.)

- Advanced knowledge of health care financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form).

- Advanced understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG’s), Ambulatory Patient Groups (APG’s), Ambulatory Payment Classifications (APC’s), an