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

Job Description

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 assess 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 use of 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 favorable and unfavorable trends, develop recommendations to improve trends, communicate recommendations 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 Return on Investment (ROI) analysis to determine if various 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
• Demonstrated understanding of Medicaid and Medicare programs or other healthcare plans
• Analytical work experience within the healthcare industry (i.e., hospitals, network, ancillary, medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.)
• Proficiency with Microsoft Excel (formulas, PIVOT tables, PowerQuery, etc.)
• Proficiency with SQL and/or Python for retrieving specified information from data sources.
• Experience with building dashboards in Excel and Power BI
• Knowledge of healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.)
• Knowledge of healthcare data, including UM and CM data, claims, enrollment, ect.
• Knowledge of healthcare financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form)
• Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service),
• Diagnosis Related Groups (DRG’s), Ambulatory Patient Groups (APG’s), Ambulatory Payment Classifications (APC’s), and other payment mechanisms.
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• Understanding of value-based risk arrangements
• Experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in healthcare
• Ability to mine and manage information from large data sources.

Preferred Qualifications:

• Proficiency with Power BI and/or Tableau for building dashboards
• Experience with Databricks

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

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

Job Info

Job Identification: 2029736

Job Category: Finance

Posting Date: 2025-02-04T21:28:31 00:00

Job Schedule: Full time