Manager, Medical Economics

Founded in 2007, The Oncology Institute of Hope and Innovation (TOI) is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. TOI is dedicated to offering cutting edge, evidence-based cancer care to a population of more than 1.7 million patients including clinical trials, stem cell transplants, transfusions, and other care delivery models traditionally associated with the most advanced care delivery organizations. With 100+ employed clinicians and more than 700 teammates in 75+ clinic locations and growing. TOI is changing oncology for the better.

JOB PURPOSE AND SUMMARY:

A Manager of Medical Economics plays a critical role in healthcare organizations, particularly in managed care settings such as health insurance companies, accountable care organizations (ACOs), or healthcare provider groups. This role involves analyzing and interpreting complex healthcare data to support strategic decision-making, cost containment efforts, and the optimization of healthcare delivery.

ESSENTIAL DUTIES AND RESPONSBILITIES:

• Oversee and manage the medical economics team to efficiently perform and improve initiatives through complex analytics and financial modeling.
• Perform statistical population health utilization, cost, and quality analytics to develop cost of care targets for at-risk populations.
• Conduct margin analysis on infusion drugs and oral drugs, identify margin drivers, run deep dive analysis to explain trends and assess opportunities.
• Perform profitability analysis on capitation as well as FFS contracts.
• Working with our RCM team, conducting in-depth reviews of claims AR and payments to assess collection results and trends, reporting findings to various internal teams and senior leadership.
• Working with business partners in Business Development, UM, Clinical/Ops, prepare financial models to assess ROI around operational expansion initiatives.
• Support and inform clinical, network and efficiency improvement initiatives through complex analytics and financial modeling using SQL language.
• Provide analytical research and due diligence for investment activities and accounting audits.
• Responsible for source system data analyses, identification of business rules and data elements for data transformation/migration into the data warehouse. Assists with data sharing and reconciliation among the various data systems as well as developing methods for standardizing data collection, database design, validation reports and analysis.
• Utilize tools for monitoring quality of data and assist in development of corrective action plans when issues are discovered.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Understanding of healthcare financing, reimbursement models, and healthcare delivery systems.
• Knowledge of healthcare policy, regulations, and their impact on reimbursement methodologies and healthcare costs.
• Familiarity with medical claims data sources, such as CMS datasets (Medicare claims), commercial claims data, and electronic health records (EHRs).

• Proficiency in statistical methods and data analysis techniques used in healthcare economics, such as regression analysis, cost-benefit analysis, and predictive modeling.
• Understanding of healthcare quality metrics and performance measures, such as Healthcare Effectiveness Data and Information Set (HEDIS) measures and other quality reporting programs.
• Strong data analysis skills to analyze large datasets, identify trends, and draw meaningful insights related to healthcare costs, utilization patterns, and outcomes.
• Proficiency in quantitative analysis and statistical software tools such as SAS, R, or Python for data manipulation and analysis.
• Ability to conduct financial analysis, including cost analysis, budgeting, and forecasting related to healthcare services and programs.
• Strong problem-solving skills to address complex healthcare economic issues, develop data-driven solutions, and make recommendations for improving efficiency and cost-effectiveness.
• Effective communication skills to present complex economic and financial concepts to non-technical stakeholders, including senior management, clinicians, and policymakers.
• Ability to think strategically and apply economic principles to support decision-making related to healthcare services, reimbursement policies, and population health management.
• Strong leadership abilities to lead and mentor a team of analysts or economists, prioritize work assignments, and collaborate effectively with cross-functional teams.
• Proficiency in project management methodologies to plan, execute, and monitor projects related to healthcare economics, ensuring timely delivery of outcomes and adherence to budget and resource allocations.
• Ability to collaborate with stakeholders across the organization, including finance, operations, clinical departments, and external partners, to align medical economics initiatives with organizational goals and objectives.
• Have a solid understanding of the healthcare industry, including healthcare financing, reimbursement systems, healthcare delivery models, and regulatory environment.

REQUIRED EXPERIENCE, EDUCATION AND/OR TRAINING:

• A bachelor's degree in a relevant field such as economics, healthcare administration, public health, health informatics, statistics, or a related field is typically required.

The estimate displayed represents the typical wage range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role. 

Pay Transparency for salaried teammates$120,000—$144,000 USD