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

Lensa; Meridian (ID); Remote; USD 70,000 - 90,000; Full time

Job summary

A leading healthcare company is seeking a Senior Analyst in Medical Economics to provide analytical support for UM and CM processes. The role involves data analysis, report creation, and collaboration with various teams to improve healthcare quality and reduce costs. Candidates should have a strong background in healthcare analytics and experience with large data sets.

Qualifications

• 5+ years of healthcare-related experience.
• Understanding of Medicaid and Medicare programs.
• Experience in healthcare analytics within hospitals, networks, or insurance.

Responsibilities

• Analyze claims and data to identify improvement opportunities.
• Collaborate with teams to add context to data analyses.
• Lead projects and develop financial reports.

Skills

Healthcare Analytics

Data Management

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

Databricks

Job description

Job Description

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 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, creating insights into the health of these processes, and improving the quality of care delivered to members. Extracts, analyzes, and synthesizes data from various sources to identify risks and opportunities.

Job Duties

1. Understand UM and CM data and provide input on data design to support complex analyses.
2. Extract and compile information from various systems to support decision-making.
3. Mine and manage information from large data sources.
4. Analyze claims and other data to identify early signs of process and outcome improvement opportunities.
5. Collaborate with clinical, finance, MedEcon teams, and other personnel to add context to data analyses and design studies related to medical interventions.
6. Work with business owners to track key performance indicators of medical interventions.
7. Identify and investigate complex issues in UM and CM operations, analyze them, and suggest corrective actions.
8. Draw actionable conclusions from analyses, make recommendations, and communicate effectively across the enterprise.
9. Analyze financial performance, identify trends, develop improvement recommendations, and communicate them to management.
10. Lead projects, contribute to ad-hoc analyses, and develop financial reports.
11. Serve as a subject matter expert on UM and CM data and improvement opportunities.
12. Provide data-driven analytics to various departments for decision-making.
13. Support financial analysis projects related to medical cost reduction.
14. Assist with ROI analysis for medical management programs.
15. Stay informed about 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 of healthcare-related experience.
• Understanding of Medicaid and Medicare programs.
• Experience in healthcare analytics within hospitals, networks, or insurance.
• Proficiency in Microsoft Excel, SQL, and/or Python.
• Experience with dashboards in Excel and Power BI.
• Knowledge of healthcare operations, data, and financial terms.
• Understanding of managed care concepts, provider reimbursement, and payment mechanisms.
• Ability to manage large data sources.

Preferred Qualifications

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

Interested current Molina employees should apply through the intranet. Molina offers competitive benefits and is an EOE M/F/D/V.