Medical Economics Behavioral Health Lead Analyst

Position Summary

We are seeking an analytical professional to join our Medical Economics – Medical Expense Review (MER) team. This individual will focus on developing savings analyses for Behavioral Health initiatives led by Medicaid Health Plans and Utilization Management Teams. The primary goals of this team are to identify and communicate with leadership specific provider, procedure, and population level trends and outliers impacting the health plans medical cost trends, and to analyze and size potential savings initiatives in coordination with clinical, finance, and network leads.

Critical to the role will also be coordinating with BH and Analytics leads across multiple teams to obtain information on actions being taken to drive savings – the key driver of building savings models to communicate results of the initiatives to leadership.

• Applicants must have relevant analytical financial experience.
• Minimum of 3‑5 years of experience with key managed care functions including provider and population analytics, provider contracting, benefit design, medical management, and knowledge of business functions and impact on financials.
• Advanced skills in Excel, and web‑based query tools to pull and analyze ad‑hoc data.
• Ability to build savings models based on a variety of utilization and cost metrics to size impact and monitor over time.
• Critical skills within Excel include use of pivot tables, formulas for financial modeling, data tagging, and creation of data visualizations to effectively communicate the trend story.
• Essential skill as reporting "super user" – able to navigate, comprehend, and tease out findings with enterprise reporting tools.
• Comfortable presenting to executive audience with high skill level to build PowerPoint visuals and articulate key issues and actions efficiently.
• Demonstrates critical thinking and expresses ideas clearly, concisely, and logically from a cross‑functional perspective.
• Ability to manage conflicting priorities and multiple projects concurrently; demonstrates initiative, innovation and leadership in achieving results.
• Ability to learn new technologies and analytic approaches.

• SQL coding skills that may be beneficial, including the ability to run ad‑hoc analyses to answer specific clinical or financial questions for the Account, Finance, UM, or Network teams.
• Extensive knowledge of managed care and how provider reimbursement policies relate to the control of medical claims costs.
• Full comprehension of provider contracts and the potential impact the regulatory/legislative environment has on reimbursement strategies.
• Understanding of the healthcare industry, including differentiation between inpatient and outpatient services, facility and professional claims, and impacts from population dynamics.
• Experience in underwriting, sales, product development, or network management.
• SQL coding experience is preferred but not required.

• Bachelor's Degree in business, finance, or related field OR equivalent experience.

This remote role does not support visas at this time.

40 hours per week.

Full time.

The typical pay range for this role is $60,300.00 – $. This range represents the base hourly rate or base annual full‑time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on experience, education, geography, and other relevant factors. This position is eligible for a CVS Health bonus, commission or short‑term incentive program in addition to the base pay range listed above.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. Benefits include medical, dental, and vision coverage; paid time off; retirement savings options; wellness programs; and other resources based on eligibility.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.