Director, Medical Economics - REMOTE

Molina Talent Acquisition; United States; Remote; USD 130,000 - 170,000; Full time

Job summary

Molina Healthcare is seeking a senior leader to guide the Medical Economics team in analyzing and synthesizing data to identify cost-saving opportunities across Medicaid and LTSS/Behavioral Health focus areas.

The role involves driving trend reviews, coordinating with shared services, and developing tools to track savings and performance while mentoring staff and collaborating with cross-functional teams.

Qualifications

• At least 8 years in health care analytics and/or medical economics.
• At least 3 years management/leadership experience.
• Advanced proficiency building dashboards in Excel, Power BI, and/or Tableau.
• Advanced knowledge of Medicaid/Medicare programs.
• Experience retrieving information from data sources.
• Strong verbal and written communication skills.

Responsibilities

• Oversee medical economics team and deliver work/project plans and reporting.
• Recruit, hire, onboard, mentor, and manage staff.
• Lead trend management reviews with health plans to identify opportunities.
• Coordinate with shared services for quarterly trend reviews and analyses.
• Lead trend mitigation and savings sizing with health plans.
• Maintain core trend tools and improve data structures.
• Coordinate data views for oversight of initiatives and trends.
• Develop scoreable action item tracking tools for savings opportunities.
• Prioritize Medical Economics requests and governance.
• Act as primary contact between Medical Economics Medicaid trend team and shared services.

Skills

Healthcare analytics

Leadership

Dashboard development

Data analysis

Communication

Education

Bachelor's degree

Tools

Excel

Power BI

Tableau

Job description

JOB DESCRIPTION

Job Summary

Leads and directs team responsible for medical economics analysis activities including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities and improve financial performance. Collaborates with health plans to identify and track savings opportunities. Drives trend performance review process to guide and influence decision-making related to clinical programs, initiatives, and strategy for Medicaid line of business and LTSS / Behavioral Health focus areas.

Essential Job Duties

• Provides oversight for medical economics team and activities ensuring delivery of work/project plans, required reporting, development of savings tracking tools and performance/data management improvement initiatives.
• Recruits, hires, onboards, mentors, develops, and manages Medical Economics staff.
• Participates or leads standard trend management review with health plans/shared services to identify performance and trend mitigation opportunities.
• Coordinates with shared services functions (payment integrity, national contracting, actuarial, etc.) to conduct quarterly deep dive trend reviews and opportunity analyses.
• Coordinates trend mitigation strategies with health plans and shared services. Leads corresponding savings sizing and tracking processes and performs consistent follow-up on issues and opportunities identified.
• Ensures core trend tools are maintained to reflect any changes in the business or data structure and coordinates efforts to improve and build on existing tools.
• Coordinates analytical views of data for oversight of initiatives and impact on trends.
• Leads team in development of scoreable action item (SAI) tracking tools for savings opportunities in conjunction with SAI leads.
• Manages intake and prioritization for Medical Economics requests.
• Coordinates data management advocacy structure and set organizational standards.
• Acts as primary point of contact between Medical Economics Medicaid trend team and shared services.
• Stays abreast of professional developments and industry trends

Required Qualifications

• At least 8 years of health care analytics and/or medical economics experience, or equivalent combination of relevant education and experience.
• At least 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 (Fee-for-Service), Diagnosis Related Groups (DRG’s), Ambulatory Patient Groups (APG’s), Ambulatory Payment Classifications (APC’s), 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.

Preferred Qualifications

• Experience in complex managed care.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V