Sr Analyst, Medical Economics (Clinical Analytics UM/CM) - REMOTE

Lensa; Akron (OH); Remote; USD 66,000 - 130,000; Full time

Job summary

A leading healthcare company is seeking a Senior Analyst in Medical Economics to support clinical operations through data analysis. This role involves extracting insights from complex datasets, collaborating with various teams, and driving improvements in healthcare processes. The ideal candidate will have a strong background in healthcare analytics and a bachelor's degree in a relevant field. Join a dynamic team focused on enhancing the quality of care delivered to members.

Qualifications

• 5+ years of healthcare-related experience.
• Understanding of Medicaid and Medicare programs.
• Ability to analyze large data sources.

Responsibilities

• Analyze claims and other data to identify improvement opportunities.
• Collaborate with clinical and finance teams for data analyses.
• Lead projects including ad-hoc analyses and financial reporting.

Skills

Healthcare Analytics

Data Analysis

Communication

Education

Bachelor's Degree in Mathematics

Bachelor's Degree in Economics

Bachelor's Degree in Computer Science

Bachelor's Degree in Healthcare Management

Tools

Microsoft Excel

SQL

Python

Power BI

Tableau

Job description

Sr Analyst, Medical Economics (Clinical Analytics UM/CM) - REMOTE

1 day ago Be among the first 25 applicants

Lensa is the leading career site for job seekers at every stage of their career. Our client, Molina Healthcare, is seeking professionals. Apply via Lensa today!

Job Description

Job Summary

The Senior Analyst, Medical Economics provides support and consultation to the Clinical Center of Excellence, Health Plan, and Finance teams through analyzing key business issues related to UM and CM processes and outcomes, as well as their impact on medical cost, utilization, and revenue for multiple Molina Healthcare products. They understand and assess critical UM and CM data, design and develop reports to monitor processes and outcomes, and identify root causes to drive innovation and improvements.

Responsible for understanding UM and CM data and creating insights into the health of these processes and outcomes, with the goal of improving the quality of care delivered to members. Extracts, analyzes, and synthesizes data from various sources to identify risks and opportunities.

Job Duties

• Understand UM and CM data and provide input on data design to support complex analyses
• Extract and compile information from various systems to support decision-making
• Mine and manage large data sources
• Analyze claims and other data to identify early signs of process and outcome improvement opportunities
• Collaborate with clinical, finance, and MedEcon teams to add context to data analyses and design studies related to medical interventions
• Track key performance indicators of medical interventions
• Identify and investigate complex issues in UM and CM operations, analyze problems, and suggest corrective actions
• Draw actionable conclusions from analyses, make recommendations using healthcare analytics and predictive modeling, and communicate effectively across the organization
• Analyze financial performance, identify trends, develop recommendations, and communicate with management
• Lead projects including ad-hoc analyses, financial reporting, and presentations
• Serve as subject matter expert on UM and CM data and improvement opportunities
• Provide data-driven analytics to various departments for decision-making
• Support financial analysis related to medical cost reduction initiatives
• Assist with ROI analysis for medical management programs
• Stay informed on Medicaid and Medicare reforms and their impact on Molina Healthcare

Job Qualifications

Required Education: Bachelor's Degree in Mathematics, Economics, Computer Science, Healthcare Management, or related field.

Required Experience, Knowledge, Skills, And Abilities:

• 5+ years of healthcare-related experience
• Understanding of Medicaid and Medicare programs
• Experience with healthcare analytics, claims, and operational data
• Proficiency with Microsoft Excel (formulas, pivot tables, PowerQuery)
• Proficiency with SQL and/or Python for data retrieval
• Experience building dashboards in Excel and Power BI
• Knowledge of healthcare operations and data, including UM and CM data, claims, and coding systems (ICD-10, CPT, HCPCS, NDC)
• Understanding of managed care concepts, provider reimbursement, risk adjustment, capitation, FFS, DRGs, and value-based arrangements
• Ability to analyze large data sources and quantify operational and financial metrics

Preferred Qualifications

• Proficiency with Power BI and/or Tableau
• Experience with Databricks

To all current Molina employees: Please apply through the intranet job listing.

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

#PJCorp

Pay Range: $66,456 - $129,590 / ANNUAL

• Actual compensation may vary based on location, experience, education, and skills.

Additional Details

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Research, Analyst, and IT
• Industries: IT Services and Consulting

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