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

Lensa; Milwaukee (WI); Remote; USD 66,000 - 130,000; Full time

Job summary

A leading company in healthcare analytics is seeking a Senior Analyst to provide insights into utilization management and clinical processes. The role involves data analysis, reporting, and collaboration with various teams to enhance healthcare delivery. Candidates should have a strong background in healthcare analytics, data management, and communication skills.

Qualifications

• 5+ years of related experience in healthcare.
• Understanding of Medicaid and Medicare programs.
• Proficiency with SQL and/or Python for data retrieval.

Responsibilities

• Analyze claims and data to identify improvement opportunities.
• Provide data-driven analytics to support decision making.
• Lead projects to completion with financial report development.

Skills

Analytical

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

Job description

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

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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 process and outcomes, as well as those program impacts on medical cost trends. With those root causes identified, drives innovation by creating tools to monitor trend drivers and provide recommendations to senior leaders on UM and CM improvements.

Responsible for understanding UM and CM data and creating insights into the health of the process and outcomes of these major areas of the company on improving the quality of care delivered to our 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 key required data design to support complex UM and CM analyses
• Extract and compile information from various systems to support executive decision-making
• Mine and manage information from large data sources
• Analyze claims and other data sources to identify early signs of UM and CM process and outcome improvement opportunities
• Work with clinical, finance, MedEcon teams, and other personnel to bring supplemental context/insight to data analyses, and design and perform studies related to the quantification of medical interventions.
• Work with business owners to track key performance indicators of medical interventions
• Proactively identify and investigate complex suspect areas regarding UM and CM operations and their impact on medical cost, initiate in-depth analysis of the suspect/problem areas, and suggest a corrective action plan
• Draw actionable conclusions based on analyses performed, make recommendations through healthcare analytics, predictive modeling, and communicate those conclusions effectively to audiences at various levels of the enterprise
• Analyze the financial performance of all Molina Healthcare products, identify trends, develop recommendations to improve trends, and communicate those to management
• Lead projects to completion by contributing to ad-hoc data analyses, development, and presentation of financial reports
• Serve as subject matter expert on UM and CM data, reports, and improvement opportunities based on analyses
• Provide data-driven analytics to Clinical COE, Finance, Claims, Medical Management, Network, and other departments to enable critical decision making
• Support Financial Analysis projects related to medical cost reduction initiatives
• Support Medical Management by assisting with ROI analysis to determine if programs will lead to value
• Keep abreast of 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 related experience in healthcare
• Understanding of Medicaid and Medicare programs or other healthcare plans
• Analytical work experience within healthcare (e.g., hospitals, network, ancillary, medical facilities, healthcare vendors, insurance, large physician practices, managed care organizations)
• Proficiency with Microsoft Excel (formulas, PIVOT tables, PowerQuery, etc.)
• Proficiency with SQL and/or Python for data retrieval
• Experience with building dashboards in Excel and Power BI
• Knowledge of healthcare operations (utilization management, disease management, HEDIS, claims processing, etc.)
• Knowledge of healthcare data, including UM and CM data, claims, enrollment, etc.
• Knowledge of healthcare financial terms (e.g., PMPM, revenue) and coding systems (ICD-10CM, CPT, HCPCS, NDC)
• Understanding of managed care concepts and provider reimbursement principles (risk adjustment, capitation, FFS, DRGs, APCs, etc.)
• Experience in quantifying and analyzing financial, operational, and utilization metrics
• Ability to mine and manage large data sources

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 skill level.

Additional Details

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

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