Senior Long -Term Care - Rate Setting Analyst

Gainwell Technologies LLC; United States; Remote; USD 110,000 - 150,000; Full time

Benefits offered by this job

Remote work options

Comprehensive health benefits

Job summary

Gainwell Technologies is seeking a Senior Long-Term Care - Rate Setting Analyst to lead rate-setting model development for Wisconsin Medicaid and related programs. You will apply advanced data analysis to interpret policy impacts and drive reimbursement outcomes for MCOs and the LTC ecosystem.

You will collaborate with internal teams, translate business needs into data and policy requirements, and monitor policy changes to inform strategic decisions.

Qualifications

• 6+ years of experience in business analysis, financial modeling, or health policy analysis

Responsibilities

• Lead the development, enhancement, and documentation of rate-setting models for long-term care programs
• Use advanced analytical techniques and large datasets to evaluate costs, trends, and reimbursement outcomes
• Assess how rate changes, policy updates, and cost drivers affect MCOs
• Translate business needs into data, system, and policy requirements
• Research reimbursement methodologies and provide recommendations for improvements
• Support capitated rate-setting methodologies for contracted MCOs
• Validate the accuracy of rates produced by models
• Monitor State and Federal policy changes, esp. Wisconsin Medicaid
• Prepare analyses, presentations, and recommendations for leadership and clients

Skills

Data analysis

SQL

Excel

Policy analysis

Medicaid knowledge

Rate setting

Statistical modeling

Communication

Education

Bachelor's degree in Public Administration/Public Policy/Economics/Statistics/Healthcare Administration/Finance

Master's degree preferred

Tools

SQL

SAS

R

SPSS

Job description

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development.

Summary

As a Senior Long -Term Care - Rate Setting Analyst at Gainwell, you will take a lead role in developing and maintaining rate‑setting methodologies that support a large, complex Medicaid long‑term care program. You will apply deep data expertise, interpret policy impacts — particularly within Wisconsin Medicaid — and understand how rate decisions affect Managed Care Organizations (MCOs) and the broader long‑term care ecosystem.

Bring your analytical strengths and passion for public service to a team committed to improving program transparency, efficiency, and outcomes for the communities we serve.

Here are the details on this position.

Your role in our mission

Play a critical part in ensuring rate‑setting and reimbursement strategies meet program, policy, and organizational goals.

- Lead the development, enhancement, and documentation of rate‑setting models for long‑term care programs

- Use advanced analytical techniques and large datasets to evaluate costs, trends, and reimbursement outcomes

- Assess how rate changes, policy updates, and cost drivers affect Managed Care Organizations (MCOs)

- Translate business needs into clear data, system, and policy requirements

- Research reimbursement methodologies, program operations, and the long‑term care ecosystem to recommend improvements

- Support the development and implementation of capitated rate‑setting methodologies for contracted MCOs

- Validate the accuracy and sufficiency of rates produced by established models

- Monitor State and Federal policy changes — with emphasis on Wisconsin Medicaid — and assess their operational and financial impact

- Partner with internal teams, business leaders, and external stakeholders to promote transparency and alignment in rate‑setting practices

- Prepare written analyses, presentations, and recommendations for leadership, clients, and technical teams

What we're looking for

- 6+ years of experience in business analysis, financial modeling, health policy analysis, Medicaid policy analysis, public administration, or public sector program evaluation

- Strong data expertise, including understanding how rate‑setting decisions impact Managed Care Organizations (MCOs)

- Experience interpreting public policy, preferably within healthcare and/or Wisconsin MedicaidUnderstanding of the Long-Term Care (LTC) ecosystem, including program structures and reimbursement models

- Advanced skills in Excel and/or analytical tools such as R, SAS, STATA, or SPSS

- Strong statistical analysis, quantitative modeling, and data interpretation skills, with the ability to translate complex findings into actionable recommendations

- Strong communication skills to translate complex analytical work into clear, actionable insights

- Ability to work independently, manage timelines, and support multiple projects at once

- Bachelor's degree in Public Administration, Public Policy, Economics, Statistical Analysis, Healthcare Administration, Finance, or a related field; master's degree preferred

What sets you apart

- Experience evaluating government, business, or healthcare policies that affect internal and external partners

- Experience working with Medicaid programs, rate‑setting methodologies, or capitated payment models

- Experience analyzing large datasets and developing quantitative or statistical models

- Ability to write and present comprehensive reports, analyses, and policy summaries

- Strong problem‑solving skills and a track record of recommending improvements to business or technical processes

- Experience with SQL or data warehouse tools

- Education or training in public policy, economics, statistics, or a related field

- Familiarity with State/Federal regulations influencing long‑term care and Medicaid operations

- Professional experience working within a state Medicaid agency, state policy office, healthcare policy organization, or government‑funded healthcare program

- Experience working for or directly supporting Managed Care Organizations (MCOs), including an understanding of managed care financing and oversight

- Knowledge of Medicaid policy, healthcare reimbursement methodologies, actuarial concepts, and capitation rate development

- Experience evaluating the financial and operational impacts of capitation rates, rate adjustments, and value‑based payment arrangements

What you should expect in this role

- Fully remote options from Contiguous US locations only

- #LI-HC1

The pay range for this position is [[salaryMin]] - [[salaryMid]] per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits , and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.