Director, Medical Economics – REMOTE

About This Opportunity

We are representing a confidential managed care organization seeking a Director, Medical Economics to lead a remote team focused on medical economics analysis and financial performance optimization. This is a fully remote position based in the United States.

Our client operates within the Medicaid and Medicare space, delivering critical health care services. As Director, you will oversee analytical activities that drive trend performance, identify savings opportunities, and influence strategic decision-making across clinical programs and initiatives.

Responsibilities

• Lead and manage a medical economics team, including recruitment, onboarding, mentoring, and professional development
• Oversee medical economics analysis activities, extracting and synthesizing data from multiple sources to identify financial risks and opportunities
• Direct the trend performance review process, collaborating with health plans and shared services to guide clinical program strategy
• Coordinate quarterly deep dive trend reviews and opportunity analyses with payment integrity, contracting, and actuarial teams
• Lead trend mitigation strategies, savings sizing processes, and tracking efforts with consistent follow-up on identified opportunities
• Ensure maintenance and improvement of core trend tools to reflect business and data structure changes
• Develop scoreable action item tracking tools for savings opportunities
• Manage intake and prioritization of Medical Economics requests
• Serve as primary liaison between the Medicaid trend team and shared services functions
• Establish organizational standards for data management and analytical frameworks

What We're Looking For

Required:

• 8+ years of health care analytics and/or medical economics experience
• 3+ years of management or leadership experience
• Bachelor's degree in statistics, mathematics, economics, computer science, health care management, or related field
• Advanced understanding of Medicaid and Medicare programs
• Advanced analytical experience within the health care industry (hospitals, managed care organizations, commercial health insurance, etc.)
• Advanced proficiency building dashboards in Excel, Power BI, and/or Tableau
• Deep knowledge of health care operations including utilization management, disease management, HEDIS quality measures, and claims processing
• Strong command of health care financial terms (PMPM, revenue) and standard code systems (ICD-10CM, CPT, HCPCS, NDC)
• Advanced understanding of managed care concepts and provider reimbursement principles including risk adjustment, capitation, fee-for-service, DRGs, APGs, and APCs
• Experience with value-based risk arrangements
• Proven ability to quantify, measure, and analyze financial, operational, and utilization metrics in health care
• Advanced problem-solving and critical-thinking skills with exceptional attention to detail
• Strong collaboration skills across technical and non-technical stakeholders at all organizational levels
• Excellent time-management abilities with experience managing multiple simultaneous projects
• Strong verbal and written communication skills
• Advanced Excel skills (VLOOKUPs, pivot tables) and proficiency in Microsoft Office suite

Preferred:

• Experience in complex managed care environments

How We Work with You

Get A Job.ai specializes in connecting top-tier analytics and health care leadership talent with leading organizations. When you apply through our platform:

• A dedicated recruiter from our talent team will review your qualifications and conduct an initial screening
• We will prepare and submit your profile to our client for consideration
• We will coordinate all interview scheduling and provide guidance throughout the process
• Please do not contact the client directly; all communication should flow through Get A Job.ai

Pay

Compensation details will be discussed during the screening process based on experience and qualifications.

Equal Opportunity

Get A Job.ai is committed to fostering an inclusive recruitment process. We welcome applications from candidates of all backgrounds and work to ensure equitable access to career opportunities.