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ProgenyHealth Vice President Healthcare Economics - Remote in Plymouth Meeting, Pennsylvania

ProgenyHealth is a leading provider of care management solutions for maternal and infant populations. We partner with health plans and their obstetric, perinatal, and neonatal providers to work collaboratively in developing a plan of care specific to the needs of each member/family – from prenatal care to delivery to admission to the intensive care nursery until they are safely transitioned from the hospital, up to the first year of an infant’s life. Our program promotes appropriate utilization, improves access, educates members and their families, addresses social determinants of health, reduces costs, and improves outcomes.

Job Role

The VP of Healthcare Economics provides executive leadership to the health economics team and supports ProgenyHealth functional leaders (growth, client success, health services, payment assurance, enterprise analytics), in conjunction with Finance, to articulate and share data that supports ProgenyHealth’s ROI to existing and prospective customers. The VP acts as a subject matter expert, in collaboration with the healthcare economics team, to research and investigate business issues, reimbursement changes and geographical differences in evaluating the financial performance of ProgenyHealth’s services.

The output of the research and analysis will be used to demonstrate value to existing clients, provide compelling opportunity analysis to prospective clients, and further internal benchmarks to identify opportunities for automation / efficiencies in the company’s overall health economics approach. Examples of output and analysis include: benchmarks, cost drivers, utilization trends and risk adjustment.

The VP HE will serve in an outward facing role, presenting the results of the health economics research and analysis to existing and prospective clients.

Responsibilities Include:

  • Review and provide feedback on client contracts around ROI guarantees and methodology.

  • Provide executive leadership to client and PH teams to develop the Medical Economics analyses and functions required for successful implementation of PH’s [Utilization Management, Case Management, Payment Assurance] services, including monitoring and evaluating outcomes and performance.

  • Participate in the strategic development of contracts and business relationships related to new products and markets.

  • Responsible for ensuring terms and commitments are consistent with the corporation's goals and objectives. Play an integral role in all major business decisions, defining the estimated financial impact of such decisions.

  • Support the development of ProgenyHealth benchmarks using our expansive existing claims database to demonstrate subject matter expertise to the market and stream-line sales approach.

  • Lead ProgenyHealth AI initiative to:

  • Use our expansive database to drive informed decision-making and predict likely clinical and financial outcomes of care management.

  • Leverage historical claims experience and findings to apply automation / machine learning in the evaluation of claims for payment validation and assurance service line.

  • Overall responsibility for compliance and security with respect to client data, in collaboration with the technology, enterprise analytics and compliance teams.

  • Mentor healthcare economics team, act as a sounding board, refine client facing analysis to make understandable for non-technical audience.

    Qualifications:

  • Bachelor’s degree (BS/BA) is required, preferably with a quantitative major (e.g., statistics, actuarial or economics, finance) or healthcare focus (health administration).

  • Master’s degree or higher from an accredited institution with a concentration in Finance, Accounting, Business, or Healthcare Administration preferred.

  • 8+ years of experience in statistical analysis and healthcare modeling in health care/managed care with direct responsibility within a Financial Planning & Analysis (FP&A) and/or Medical Cost Management & Analysis discipline.

  • 5 or more years of progressive Medical Economics and Analytics experience within payers, providers, analytic firms and/or consulting firms supporting Population Health, ACOs and Risk Contracting.

  • Requires minimum of 5 years of experience in developing complex financial models in order to drive analyses that will support business decisions.

  • Requires general knowledge of the components underneath medical cost and utilization trends, as well as how to appropriately present year-over-year comparisons to identify variances to budget and prior year.

  • Requires knowledge of Commercial and Medicaid market sectors and products.

  • Work experience with SAS and/or SQL creating queries, pulling large data sets, and performing data manipulations and analysis.

  • Familiarity with data visualization tools such as Tableau.

  • Experience with MS Excel functions that include working with large data sets and creating standardized reports.

  • Ability to work in a highly cross-functional and strategic position.

  • Must possess sharp analytical skills and strong organizational skills, have excellent communication skills, and the ability to create clear and articulate correspondence and documents.

  • Exceptional problem-solving skills - both conceptual and analytical. Must have experience defining problems, collecting data, establishing facts, and recommending solutions.

Benefits/Culture

Some of the benefits we offer our team are:

  • Paid Time Off

  • Medical, dental, vision benefits

  • 401K with company match

  • Short- and Long-Term Disability

  • Group Life Insurance

  • Tuition reimbursement

  • Professional development opportunities

  • Business Casual work environment

  • Team oriented events throughout the year

  • Role specific - partial or full remote work week

    ProgenyHealth positively recruits people from diverse backgrounds, including individuals with disabilities - if you need an accommodation to interview, please contact us by email: careers@progenyhealth.com

    Job location:

  • This position may be performed remotely – candidates outs ide of the Eastern PA area will be considered.

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