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Executive Director Medical Economics

Albuquerque, NM

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Location:UNMMG Office of Clinical Contract Services (OCCS)Pay Range:NegotiableJob Code:X8017# of Openings:1Position Class Code/Title:  X8017 Executive Director, Medical EconomicsFLSA: Exempt Grade: AE18FOR BEST CONSIDERATION DATE: OPEN UNTIL FILLED**MEMBERS ONLY**SIGN UP NOW***., Inc. (UNMMG) is the practice plan organization for physicians and other medical providers associated with the UNM Health Sciences Center. **MEMBERS ONLY**SIGN UP NOW***., Inc. is a New Mexico non-profit corporation and is an equal opportunity employer. UNMMG offers a competitive salary and an attractive benefit package which includes medical, dental, vision, and life insurance as well as tuition assistance, paid leave and 403b retirement for benefits eligible employees.The Office of Clinical Contract Services (OCCS) is seeking an Executive Director, Medical Economics. This position is responsible for analytics related to Value Based/Risk contracting initiatives. This position is also charged with the creation of executive summary reports as well as detailed custom reports as needed to reflect analysis. Familiarity with healthcare concepts, reimbursement methodology and demonstrated experience in conducting detailed analysis is required.The following statements are intended to describe, in broad terms, the general functions and responsibility levels characteristic of positions assigned to this classification. They should not be viewed as an exhaustive list of the specific duties and prerequisites applicable to individual positions that have been so classified.SUMMARY Provides technical and analytical leadership and support to the Office of Managed Care and Clinical Contract Services (OMCS), by performing strategic, broad-impact financial, utilization, and cost analysis and reporting. Leads and coordinates the design and implementation of financial/utilization/accounting/budget reports to the OMCS, and its various care management and business operations. Oversees the Clinical Practice Excellence initiative to include analytics, quality, metrics and program design. Provides detailed financial analysis of managed care operations, and designs/implements data analysis processes to support OMCS initiatives, such as outcomes reporting, shared savings and bundled payment/episode of care contracting. Develops and delivers financial and business policies and procedures related to data management and documentation, and documents the processes and procedures, associated with managed care data reporting and analytics.  Will support training programs, as appropriate.DUTIES AND RESPONSIBILITIESOversees the design, documentation, and implementation of various integrated systems and applications for periodic and ad hoc financial and operational reporting associated with the OMCS programs, utilizing complex electronic financial information from internal and external sources.Oversees the Clinical Practice Excellence initiative.Compiles and analyzes financial information from all components of the organization, and develops integrated revenue/expense analyses, projections, reports, and presentations.Effectively interprets data and communicates findings/recommendations both orally and in writing to diverse groups, internal to the business entity, and to outside parties.Under the direction of the Senior Executive Director for Managed Care and Clinical Contract Services, coordinates, compiles, and analyzes the financial/cost impact of new and existing provider contracts and other payment changes, including global payment and risk-sharing arrangements, utilizing complex spreadsheet and database applications.Collaborates with and coordinates all components to ensure consistent reporting and adherence to federal/state financial reporting regulations and guidelines, outside constituencies, customer reporting requirements, and conformity with UNM HSC fiscal policies and procedures.Works collaboratively with the finance and actuarial staff in support of on-going trend analysis by identifying and analyzing drivers of change in unit cost and the impact of unit cost on medical cost trends by category of care and by product /line of business.Analyzes, designs, documents, and implements internal financial reporting systems and procedures for the organization or business entity.Designs, coordinates, and implements training programs for personnel within the organization and its components regarding the nature and application operating policies and procedures.Provides leadership, administrative management, and operational coordination to various technical, professional, and/or administrative personnel engaged in specified project activities, as appropriate to the position.Performs miscellaneous job-related duties as assigned.MINIMUM JOB REQUIREMENTSBachelor's degree in related field with at least 10 years of experience that is directly related to the duties and responsibilities specified? Verification of education and licensure will be required if selected for hire.KNOWLEDGE, SKILLS, AND ABILITIES REQUIREDDemonstrated knowledge of managed care concepts and the financial relationship between payors and providers.Possess strong analytic and technical skills and the ability to translate complicated data into useable knowledge.In-depth knowledge and understanding of health care claims data, coding schemes (CPT, ICD-9/10, OPPS, DRGs) and risk adjustment.Knowledge and understanding of various types of contractual relationships and reimbursement methods between payors and providers for hospital, physician, and ancillary services, including global and bundled payments, and risk-sharing arrangements.Knowledge of managed care service operations and terminology, such as premiums, PMPM, risk adjustment, case severity, benefit plan designs, medical cost ratio, cost controls, etc.Knowledge of Federal and State financial and managed care regulations.Knowledge of the principles, processes, and standards for integrated financial analysis and reporting as related to a public institution.Ability to develop and present educational programs and/or workshops.CONDITIONS OF EMPLOYMENTMust be employment eligible as verified by the U.S. Dept. of Health and Human Services Office of Inspector General (OIG) and the Government Services Administration (GSA).Must pass a pre-employment criminal background check.Fingerprinting, and subsequent clearance, is required.Must provide proof of varicella & MMR immunity or obtain vaccinations within 90 days of employment.Must obtain annual influenza vaccination.If this position is assigned to a clinical area, successful candidate will be required to complete a pre-placement medical evaluation/health screen.  Required N-95 mask fitting, testing, vaccinations to include annual TST, Tdap, and Hepatitis B will be determined based on location and nature of position.WORKING CONDITIONS AND PHYSICAL EFFORTWork is normally performed in a typical interior/office work environment.No or very limited exposure to physical risk.No or very limited physical effort required.

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