Manager, Medicaid Payment Model Analytics Consultant - Remote

Optum; Washington (District of Columbia); Remote; USD 113,000 - 193,000; Full time

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase plan

401k contribution

Job summary

Optum Serve Consulting/The Lewin Group (OSC/Lewin) seeks a Health Data Analytics Consultant to analyze Medicaid data (TAF/TAF) and translate policy into analytic specs for CMS Innovation Center models. You will develop SQL code, apply Python tools, and support attribution, payment calculations, and quality measures.

The role offers remote work from anywhere in the U.S. with office presence in the DC/Minneapolis area as needed, and requires collaboration with senior analysts and project

Qualifications

• 3+ years of experience working with healthcare data.
• 1+ year of direct experience working with Medicaid data.
• Experience conducting quantitative analysis using healthcare claims and enrollment data.
• Experience translating business, policy, or program requirements into analytic specifications.
• Understanding of Medicaid eligibility, enrollment, claims, and encounter data.
• Familiarity with Medicaid payment and delivery systems, including managed care and fee-for-service environments.
• Proven excellent oral and written communication skills and a focus on meeting deadlines.
• Demonstrated attention to detail and commitment to producing accurate, high-quality work.

Responsibilities

• Conduct hands-on analysis of Medicaid data, including T-MSIS data, to support payment model implementation and operations.
• Translate policy and methodology into data specifications, business rules, and analytic code.
• Develop, test, and maintain SQL code to build analytic files, define populations, and produce model outputs.
• Use Python and other analytic tools to support data processing, analysis, and quality assurance.
• Support attribution, payment calculation, quality measurement, and other operational methodologies used in healthcare payment models.
• Assess Medicaid data quality and completeness across states and delivery systems.
• Analyze Medicaid claims, encounter, enrollment, provider, and other program data for client needs.
• Develop and maintain documentation of specifications, methodologies, code, assumptions, and QC procedures.
• Perform quality assurance reviews and validation checks on analytic outputs and deliverables.
• Prepare tables, reports, and presentations for technical and non-technical audiences.
• Collaborate with policy, operations, and analytic staff as a project team member.

Skills

Healthcare data

Medicaid data

SQL

Python

Data analysis

Communication skills

Attention to detail

Tools

Snowflake

Databricks

CMS IDR

T-MSIS

Job description

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. Optum Serve Consulting/The Lewin Group (OSC/Lewin), a premier national health care and human services consulting and policy analysis firm, brings 50 years of experience finding answers and solving problems for leading organizations in the public, non-profit, and private sectors. In the wide-ranging field of health human services consulting, OSC/Lewin provides both depth and breadth of expertise. Currently, OSC/Lewin has more than 250 consultants drawn from industry, government and academia. They all share a solid commitment to OSC/Lewin's core values of objectivity, integrity, analytical innovation, vision, and dedication to client satisfaction. At OSC/Lewin, we help federal, state, and other decision-makers strengthen health and human services programs, make informed policy choices, and implement critical initiatives. The Health Data Analytics Consultant will support Medicaid data and policy work for CMS Innovation Center payment models, including the LEAD model. This is a hands-on analytic role focused on working directly with Medicaid data, including T-MSIS Analytic Files (TAF), to support model implementation and operations. The consultant will help translate policy and methodology into data specifications, code, analyses, and operational outputs, including attribution, payment calculations, and quality measurement. This person will work closely with senior analysts, policy experts, and project leadership to deliver accurate, well-documented analytic products. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Primary Responsibilities

• Conduct hands-on analysis of Medicaid data, including T-MSIS data, to support payment model implementation and operations
• Translate policy and methodology into data specifications, business rules, and analytic code
• Develop, test, and maintain SQL code to build analytic files, define populations, and produce model outputs
• Use Python and other analytic tools, as appropriate, to support data processing, analysis, and quality assurance
• Support attribution, payment calculation, quality measurement, and other operational methodologies used in healthcare payment models
• Assess Medicaid data quality and completeness and account for differences across states, delivery systems, and managed care and fee-for-service environments
• Analyze Medicaid claims, encounter, enrollment, provider, and other program data to support client needs
• Develop and maintain documentation of specifications, methodologies, code, assumptions, and quality control procedures
• Perform quality assurance reviews and validation checks on analytic outputs and deliverables
• Prepare tables, reports, presentations, and other materials that summarize analytic findings for technical and non-technical audiences
• Work effectively and cooperatively with policy, operations, and analytic staff as a member of project teams

Required Qualifications

• 3+ years of experience working with healthcare data in a consulting, research, government, or business environment
• 1+ year of direct experience working with Medicaid data, including T-MSIS Proficiency programming in SQ
• Experience conducting quantitative analysis using healthcare claims and enrollment data
• Experience translating business, policy, or program requirements into analytic specifications
• Understanding of Medicaid eligibility, enrollment, claims, and encounter data
• Familiarity with Medicaid payment and delivery systems, including managed care and fee-for-service environments
• Proven excellent oral and written communication skills and a focus on meeting deadlines
• Demonstrated attention to detail and commitment to producing accurate, high-quality work

Preferred Qualifications

• Experience working with Medicaid data across multiple states
• Experience working in the CMS Integrated Data Repository (IDR) in Snowflake or Databricks environments
• Experience working in Snowflake
• Programming experience in Python
• Experience supporting healthcare payment models, value-based care programs, or alternative payment models
• Experience working in large healthcare data warehouse environments, such as the Chronic Conditions Warehouse (CCW)
• Experience preparing technical documentation, specifications, and analytic reports
• All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $112,700 - $193,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.