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Fallon Health Medical Economics Consultant-Medicaid in Worcester, Massachusetts


About Fallon Health

Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fallonhealth.org.

Position Summary:

The Medical Economics Consultant will partner with the Vice President, Medical Economics and Line of Business owner as a subject matter expert in data and analysis, demonstrating an in-depth understanding of financial, clinical, and other business data. This position will extract, analyze and interpret Healthcare data to uncover trends and assist in managing and understanding the Line of Business medical cost. The Medical Economics Consultant demonstrates business intelligence, being able to apply analyses to both financial as well as clinical operations in a meaningful manner. The position works directly with operational leadership in the design and development of analytical capabilities, reports, and dashboards needed for short and long-term decision-making as it pertains to a specific line of business. This individual provides complex ad hoc analysis and reporting as directed by management to include the evaluation of financial, operational, clinical and general business programs and processes. The Medical Economics Consultant is responsible for data quality and data integrity as they relate to reporting and analysis activities. This position provides data in support of Actuarial, Financial, and Utilization analyses, as it relates to medical cost improvements and alternative pricing strategies.


Primary Job Responsibilities:

Analysis, Decision Support, and Business Intelligence – 60%

  • Provide cost and utilization quantitative and qualitative analyses for a line of business

  • Provide actionable analyses and reports that help monitor line of business performance and drive decision making to reduce total medical expense

  • Perform medical cost and utilization predictive analytics for a line of business

  • Perform data mining to discover clinical patterns and relationship, present to Senior Management or respective committee

  • Provide advanced analytical support for clinical initiatives including development, evaluation and ROI analyses

  • Perform analyses of actual cost and utilization against line of business benchmarks or targets

Financial and Clinical Model Design and Support – 30%

  • Assist the line of business in designing initiatives to impact cost drivers, including measurement and monitoring of initiatives

  • Design and perform program evaluation for clinical activities

  • Develop financial pro forma in support of line of business payment methodology

  • Present financial analysis to Senior Management and line of business partners (ACO, HCO, PHO)

Ad Hoc Support – 10%

  • Provide support for ad-hoc requests that require clinical, financial, regulatory, pharmacy and operational analysis and reporting

  • Prepare reports and supporting analysis for internal and external stakeholders focused on reducing costs and financial performance against target

  • Be a resource for other members of the department, as well as line of business owner and stakeholders

  • Be a subject matter expert, train and guide other team members within the department as well as others within the organization, in data understanding and analytical processes




Bachelor’s degree in Business, Finance or Public Health


Minimum of 7 years clinical analytical experience in healthcare environment


Location US-MA-Worcester

Posted Date 3 weeks ago (11/20/2019 12:44 PM)

Job ID 5802

# Positions 1

Category Finance