Director, Medical Economics & Medicaid Strategy

Molina Healthcare

Long Beach (CA)

Hybrid

USD 123,000 - 240,000

Full time

14 days+

A complete application in a minute

Tailored resume and cover letter, ready to send.

Get past ATS filters

Job summary

Molina Healthcare in Long Beach, CA, seeks a senior leader to manage a Medical Economics team responsible for extracting and analyzing data to identify risks and opportunities and improve financial performance in Medicaid and LTSS/Behavioral Health programs.

You will guide trend reviews with health plans, partner with shared services, and drive tooling, dashboards, and data management to support savings and strategic decisions. Strong leadership, analytics, and communication skills are essential.

Qualifications

8+ years of health care analytics and/or medical economics experience, or equivalent combination of relevant education and experience.
3+ years management/leadership experience.
Bachelor’s degree in statistics, mathematics, economics, computer science, health care management or related field.
Advanced understanding of Medicaid and Medicare programs or other health care plans.
Advanced analytical work experience within the health care industry (i.e., hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.)
Advanced proficiency with retrieving specified information from data sources.
Advanced experience with building dashboards in Excel, Power BI, and/or Tableau and data management.
Advanced knowledge of health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.)
Advanced knowledge of health care financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form).
Advanced understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS, DRGs, APG, APCs, and other payment mechanisms.
Advanced understanding of value-based risk arrangements
Advanced experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in health care.
Advanced problem-solving skills.
Advanced critical-thinking and attention to detail.
Ability to effectively collaborate with technical and non-technical stakeholders, and engage with various levels within the organization.
Strong time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
Strong verbal and written communication skills.
Proficient in Microsoft Office suite products, advanced skills in Excel (VLOOKUPs and pivot tables) / applicable software program(s) proficiency.

Responsibilities

Oversee medical economics team and ensure delivery of work/projects, reporting, savings tracking tools, and data management improvements.
Recruit, hire, onboard, mentor, develop, and manage Medical Economics staff.
Lead standard trend management reviews with health plans/shared services to identify performance and trend mitigation opportunities.
Coordinate with shared services (payment integrity, national contracting, actuarial, etc.) for quarterly trend reviews and opportunity analyses.
Lead trend mitigation strategies with health plans and shared services; manage savings sizing and follow-up on issues and opportunities.
Maintain core trend tools to reflect changes in business or data structure; coordinate tool improvements.
Coordinate analytical views of data for oversight of initiatives and impact on trends.
Lead development of scoreable action item tracking tools for savings opportunities with SAI leads.
Manage intake and prioritization for Medical Economics requests.
Coordinate data management advocacy and establish organizational data standards.
Serve as primary contact between Medical Economics Medicaid trend team and shared services.
Stay abreast of industry trends.