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

Lensa; Madison (WI); Remote; USD 80,000 - 100,000; Full time

Job summary

A leading company is seeking a Senior Analyst in Medical Economics to provide analytical support for UM and CM processes. The role involves data extraction, analysis, and collaboration with various teams to improve healthcare outcomes. Candidates should have a strong background in healthcare data analysis and relevant educational qualifications.

Qualifications

• 5+ years healthcare-related experience.
• Understanding of Medicaid and Medicare programs.
• Ability to analyze large datasets and generate insights.

Responsibilities

• Support data design for complex analyses.
• Analyze claims data to identify improvement opportunities.
• Provide data-driven analytics for decision-making.

Skills

Healthcare Data Analysis

Data Analysis

Communication

Problem Solving

Education

Bachelor's Degree in Mathematics

Bachelor's Degree in Economics

Bachelor's Degree in Computer Science

Bachelor's Degree in Healthcare Management

Tools

Excel

SQL

Python

Power BI

Job description

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

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 its impact on medical cost, utilization, and revenue for multiple Molina Healthcare products. Understands and assesses critical UM and CM data and designs/develops reports to monitor UM and CM processes and outcomes, as well as program impacts on medical cost trends. Creates tools to monitor trend drivers and provides recommendations to senior leaders on UM and CM improvements.

Responsible for understanding UM and CM data and creating insights into the health of these processes and outcomes, aiming to improve 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 support data design for complex analyses
• Extract and compile information from systems to support decision-making
• Manage large data sources and analyze claims data to identify improvement opportunities
• Collaborate with clinical, finance, and MedEcon teams to bring context to data analyses and design studies on medical interventions
• Track key performance indicators and investigate suspect areas in UM and CM operations
• Draw actionable conclusions, make recommendations using healthcare analytics, and communicate findings effectively
• Analyze financial performance, identify trends, and develop improvement recommendations
• Lead projects, contribute to ad-hoc analyses, and develop financial reports
• Serve as subject matter expert on UM and CM data and improvement opportunities
• Provide data-driven analytics to various departments for critical decision-making
• Support medical cost reduction initiatives and ROI analysis for programs
• Stay informed on Medicaid and Medicare reforms and their impacts

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 healthcare-related experience
• Understanding of Medicaid and Medicare programs
• Experience with healthcare data analysis (hospitals, vendors, insurance, etc.)
• Proficiency in Excel, SQL, Python, Power BI
• Knowledge of healthcare operations and data systems (claims, enrollment, coding systems)
• Understanding of managed care concepts and provider reimbursement principles
• Ability to analyze large datasets and generate insights

Preferred Qualifications

• Experience with Power BI and Tableau
• Experience with Databricks

To apply, current Molina employees should use the intranet. Molina offers competitive benefits. EOE M/F/D/V.